Healthcare Provider Details

I. General information

NPI: 1962545947
Provider Name (Legal Business Name): GARY WARBURTON DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W BALTIMORE ST ORAL AND MAX SURGERY, SUITE 1401
BALTIMORE MD
21201
US

IV. Provider business mailing address

874 DRIVER RD
MARRIOTTSVILLE MD
21104-1325
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-6195
  • Fax: 410-706-4199
Mailing address:
  • Phone: 410-465-0763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberD0066077
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberD0066077
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number61 (TEACHING)
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: