Provider Demographics
NPI:1104958685
Name:WARNER, RICK ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:ALAN
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 1:10540 COLDWATER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1268
Mailing Address - Country:US
Mailing Address - Phone:260-637-4648
Mailing Address - Fax:260-637-8990
Practice Address - Street 1:10540 COLDWATER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1268
Practice Address - Country:US
Practice Address - Phone:260-637-4648
Practice Address - Fax:260-637-8990
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008281A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice