MEDICARE: WARREN & GIBSON LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	21625	OH
2	1223G0001X	General Practice Dentistry	14470	OH
3	1223P0700X	Prosthodontics	20269	OH
4	1223G0001X	General Practice Dentistry	14584	OH

General Provider Information

NPI Number	:	1508980632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARREN & GIBSON LLC

Provider Business Mailing Address
First Line	:	5109 W BROAD ST
Second Line	:	SUITE303
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1648
Country	:	US
Telephone Number	:	614-878-9562
Fax Number	:	614-878-1468

Provider Business Practice Location Address
First Line	:	5109 W BROAD ST
Second Line	:	SUITE303
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1648
Country	:	US
Telephone Number	:	614-878-9562
Fax Number	:	614-878-1468

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. TINA M HOLSCHBACH
Credential	:
Telephone Number	:	614-878-9562

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	05/28/2009

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Directions to “WARREN & GIBSON LLC ” Practice Location

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