1356582480 NPI number — DR. RICHARD HUGH WARD D.D.S.

Table of content: DR. RICHARD HUGH WARD D.D.S. (NPI 1356582480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356582480 NPI number — DR. RICHARD HUGH WARD D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARD
Provider First Name:
RICHARD
Provider Middle Name:
HUGH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356582480
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
US HWY 160 AND NAVAJO RT. 135
Provider Second Line Business Mailing Address:
RED MESA
Provider Business Mailing Address City Name:
TEECNOSPOS
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-656-5216
Provider Business Mailing Address Fax Number:
928-656-5201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
US HWY 160 AND NAVAJO RT. 135
Provider Second Line Business Practice Location Address:
RED MESA
Provider Business Practice Location Address City Name:
TEECNOSPOS
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-656-5216
Provider Business Practice Location Address Fax Number:
928-656-5201
Provider Enumeration Date:
03/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  25305 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 25305 . This is a "DENTAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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