=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316379415
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WARNER DENTAL CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2013
-----------------------------------------------------
Last Update Date | 07/31/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14300 GALLANT FOX LN SUITE 111
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20715-4003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-805-6589
-----------------------------------------------------
Fax | 301-805-6109
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14300 GALLANT FOX LN SUITE 111
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20715-4003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-805-6589
-----------------------------------------------------
Fax | 301-805-6109
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. GARY EVERARD WARNER
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 301-805-6589
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 12139
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------