Healthcare Provider Details

I. General information

NPI: 1598932386
Provider Name (Legal Business Name): STEPHEN M WARNER DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MAPLE ST SUITE 204
SPRINGFIELD MA
01103-2202
US

IV. Provider business mailing address

130 MAPLE ST SUITE 204
SPRINGFIELD MA
01103-2202
US

V. Phone/Fax

Practice location:
  • Phone: 413-733-1306
  • Fax:
Mailing address:
  • Phone: 413-733-1306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12165
License Number StateMA

VIII. Authorized Official

Name: DR. STEPHEN M WARNER
Title or Position: ORTHODONTIST
Credential:
Phone: 413-733-1306