Healthcare Provider Details

I. General information

NPI: 1063955631
Provider Name (Legal Business Name): WARNER IMPLANT, TMD, & SLEEP APNEA CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 PENNSYLVANIA AVE SUITE 302
FORESTVILLE MD
20747-4701
US

IV. Provider business mailing address

7610 PENNSYLVANIA AVE SUITE 302
FORESTVILLE MD
20747-4701
US

V. Phone/Fax

Practice location:
  • Phone: 301-735-5137
  • Fax: 301-735-5389
Mailing address:
  • Phone: 301-735-5137
  • Fax: 301-735-5389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number12139
License Number StateMD

VIII. Authorized Official

Name: DR. GARY EVERARD WARNER
Title or Position: OWNER/DENTIST
Credential: D.D.S.
Phone: 301-357-0071