=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083747943
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN M WARNICK II DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 108 MASSINGILL RD
-----------------------------------------------------
City | PICKENS
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-878-2428
-----------------------------------------------------
Fax | 864-878-3080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 PONDSTONE DR
-----------------------------------------------------
City | EASLEY
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29642-7879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-878-2428
-----------------------------------------------------
Fax | 864-878-3080
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223D0001X
-----------------------------------------------------
Taxonomy Name | Public Health Dentistry
-----------------------------------------------------
License Number | 4101
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------