Provider Demographics
NPI:1952364457
Name:WARNER, ROBERT ELWYN (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ELWYN
Last Name:WARNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 ADAM ST
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-2038
Mailing Address - Country:US
Mailing Address - Phone:716-694-6163
Mailing Address - Fax:716-694-8639
Practice Address - Street 1:274 ADAM ST
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-2038
Practice Address - Country:US
Practice Address - Phone:716-694-6163
Practice Address - Fax:716-694-8639
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0360761122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist