Provider Demographics
NPI:1063955631
Name:WARNER IMPLANT, TMD, & SLEEP APNEA CENTER
Entity type:Organization
Organization Name:WARNER IMPLANT, TMD, & SLEEP APNEA CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:EVERARD
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-357-0071
Mailing Address - Street 1:7610 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-4701
Mailing Address - Country:US
Mailing Address - Phone:301-735-5137
Mailing Address - Fax:301-735-5389
Practice Address - Street 1:7610 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-4701
Practice Address - Country:US
Practice Address - Phone:301-735-5137
Practice Address - Fax:301-735-5389
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WARNER DENTAL CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12139261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental