Healthcare Provider Details

I. General information

NPI: 1770981821
Provider Name (Legal Business Name): DANIEL WARNER RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 06/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 S NATIONAL AVE
SPRINGFIELD MO
65810-2989
US

IV. Provider business mailing address

107 JACOLET LN NW
BAINBRIDGE ISLAND WA
98110-2744
US

V. Phone/Fax

Practice location:
  • Phone: 417-866-1010
  • Fax:
Mailing address:
  • Phone: 206-842-9890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2011016313
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: