Provider Demographics
NPI:1063223212
Name:M WARNER DMD LLC
Entity type:Organization
Organization Name:M WARNER DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-254-4454
Mailing Address - Street 1:5688 W 7800 S STE 104
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-5404
Mailing Address - Country:US
Mailing Address - Phone:801-254-4454
Mailing Address - Fax:801-757-6116
Practice Address - Street 1:12488 ROSECREST RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096
Practice Address - Country:US
Practice Address - Phone:801-254-4454
Practice Address - Fax:801-757-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental