Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 416913 | CA |
NPI | 1003188202 |
---|---|
Provider Name | Dr. Mark James Warner |
First Address | Fairfield, CA 94534-3468 |
Second Address | Fairfield, CA 94534-3468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2012 |
Last Update Date | 02/02/2012 |