MEDICARE: DR. RICHARD WAYNE WARNER D.D.S.

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	122300000X	Dentist	7116	IA

General Provider Information

NPI Number	:	1730192717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD WAYNE WARNER D.D.S.

Provider Business Mailing Address
First Line	:	1840 MADISON AVE
Second Line	:	SUITE 1
City	:	COUNCIL BLUFFS
State	:	IA
Zip	:	51503-5295
Country	:	US
Telephone Number	:	712-328-1100
Fax Number	:	712-328-0099

Provider Business Practice Location Address
First Line	:	1840 MADISON AVE
Second Line	:	SUITE 1
City	:	COUNCIL BLUFFS
State	:	IA
Zip	:	51503-5295
Country	:	US
Telephone Number	:	712-328-1100
Fax Number	:	712-328-0099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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