MEDICARE: DR. EDWARD E. WARD D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5290	OR

General Provider Information

NPI Number	:	1871590877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD E. WARD D.M.D.

Provider Business Mailing Address
First Line	:	5835 N INTERSTATE AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-4608
Country	:	US
Telephone Number	:	503-285-5307
Fax Number	:	503-286-1435

Provider Business Practice Location Address
First Line	:	5835 N INTERSTATE AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-4800
Country	:	US
Telephone Number	:	503-285-5307
Fax Number	:	503-286-1435

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	07/08/2007

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