Provider Demographics
NPI:1104841139
Name:WARNER, DENNIS MALOY (DDS)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:MALOY
Last Name:WARNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2505
Mailing Address - Country:US
Mailing Address - Phone:318-343-6188
Mailing Address - Fax:
Practice Address - Street 1:72 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2505
Practice Address - Country:US
Practice Address - Phone:318-343-6188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2308122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist