Provider Demographics
NPI:1528154762
Name:WARANOWICZ, MARK T (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:WARANOWICZ
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
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Mailing Address - Street 1:42260 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1836
Mailing Address - Country:US
Mailing Address - Phone:248-349-7900
Mailing Address - Fax:248-349-5751
Practice Address - Street 1:42260 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1836
Practice Address - Country:US
Practice Address - Phone:248-349-7900
Practice Address - Fax:248-349-5751
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI142921223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics