Healthcare Provider Details

I. General information

NPI: 1245272350
Provider Name (Legal Business Name): GARY EVERARD WARNER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 PENNSYLVANIA AVENUE SUITE 302
FORESTVILLE MD
20747
US

IV. Provider business mailing address

7603 GEORGIA AVE NW STE 403
WASHINGTON DC
20012-1617
US

V. Phone/Fax

Practice location:
  • Phone: 301-735-5137
  • Fax: 301-735-5389
Mailing address:
  • Phone: 202-723-2131
  • Fax: 202-882-6657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12139
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1000739
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: