Provider Demographics
NPI:1154739761
Name:WARNER, BLAKE MATTHEW (DDS, PHD, MPH)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:MATTHEW
Last Name:WARNER
Suffix:
Gender:M
Credentials:DDS, PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 PEEBLES ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-3210
Mailing Address - Country:US
Mailing Address - Phone:419-439-2215
Mailing Address - Fax:
Practice Address - Street 1:2300 FREEPORT RD
Practice Address - Street 2:FELDARELLI SQ 16
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-4669
Practice Address - Country:US
Practice Address - Phone:724-335-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist