Healthcare Provider Details

I. General information

NPI: 1265255723
Provider Name (Legal Business Name): WARNER ENDODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 IDYLWILD TR SUITE C
BOULDER CO
80301
US

IV. Provider business mailing address

5400 IDYLWILD TR SUITE C
BOULDER CO
80301
US

V. Phone/Fax

Practice location:
  • Phone: 720-722-4111
  • Fax: 720-823-3444
Mailing address:
  • Phone: 720-722-4111
  • Fax: 720-823-3444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. BRIAN WARNER
Title or Position: OWNER
Credential: DMD
Phone: 720-722-4111