Healthcare Provider Details

I. General information

NPI: 1710831698
Provider Name (Legal Business Name): DARIUS WARNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 W MICHIGAN ST
INDIANAPOLIS IN
46202-5211
US

IV. Provider business mailing address

4965 OAKWOOD TRL
INDIANAPOLIS IN
46268-2425
US

V. Phone/Fax

Practice location:
  • Phone: 317-445-3688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: