Active NPI
Mark James Warner, D.D.S.
- Dentist
- Fairfield, CA
National Provider Identifier
1003188202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 416913
- Practice address
- 1291 Oliver Rd
Fairfield, CA 94534-3468 - Phone
- (707) 422-7633
- Fax
- (707) 422-2630
- NPI assigned
- Feb 2, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 416913 | CA | Primary |
Addresses
Primary practice location
1291 Oliver Rd
Fairfield, CA 94534-3468
Mailing address
1291 Oliver Rd
Fairfield, CA 94534-3468
Phone (707) 422-7633
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Aug 16, 2023 through Aug 16, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 416913 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mark J Warner, DDS, Inc | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Fairfield, CA
- NPI 1811004682
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328140800000",
"number": "1003188202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1291 OLIVER RD",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945343468",
"telephone_number": "707-422-7633",
"fax_number": "707-422-2630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1291 OLIVER RD",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945343468",
"telephone_number": "707-422-7633",
"fax_number": "707-422-2630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WARNER",
"first_name": "MARK",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-02-02",
"last_updated": "2012-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "416913",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.