Healthcare Provider Details

I. General information

NPI: 1528154762
Provider Name (Legal Business Name): MARK T WARANOWICZ D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42260 GRAND RIVER AVE
NOVI MI
48375-1836
US

IV. Provider business mailing address

42260 GRAND RIVER AVE
NOVI MI
48375-1836
US

V. Phone/Fax

Practice location:
  • Phone: 248-349-7900
  • Fax: 248-349-5751
Mailing address:
  • Phone: 248-349-7900
  • Fax: 248-349-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number14292
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: