Healthcare Provider Details

I. General information

NPI: 1073297321
Provider Name (Legal Business Name): JESSICA LYN WARNER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 LOUISIANA BLVD NE STE 501
ALBUQUERQUE NM
87110-4361
US

IV. Provider business mailing address

2424 LOUISIANA BLVD NE STE 501
ALBUQUERQUE NM
87110-4361
US

V. Phone/Fax

Practice location:
  • Phone: 505-348-1036
  • Fax:
Mailing address:
  • Phone: 505-348-1036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDB-2026-0266
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: