Provider Demographics
NPI:1194796946
Name:WARNOCK, ANNA JOSE (DDS)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:JOSE
Last Name:WARNOCK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:CHRISTINA
Other - Last Name:JOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3775 CENTRAL AVE.
Mailing Address - Street 2:
Mailing Address - City:SHADYSIDE
Mailing Address - State:OH
Mailing Address - Zip Code:43947
Mailing Address - Country:US
Mailing Address - Phone:740-676-2604
Mailing Address - Fax:740-325-1869
Practice Address - Street 1:3775 CENTRAL AVE.
Practice Address - Street 2:
Practice Address - City:SHADYSIDE
Practice Address - State:OH
Practice Address - Zip Code:43947
Practice Address - Country:US
Practice Address - Phone:740-676-2604
Practice Address - Fax:740-325-1869
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2330089122300000X
OH021395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2330089Medicaid
OH2570016Medicaid