Healthcare Provider Details

I. General information

NPI: 1861611311
Provider Name (Legal Business Name): JEFFREY MICHAEL WARD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3089 E MISSION BLVD
FAYETTEVILLE AR
72703-4385
US

IV. Provider business mailing address

3699 BREAKSTONE DR
SPRINGDALE AR
72764-7872
US

V. Phone/Fax

Practice location:
  • Phone: 479-442-6995
  • Fax:
Mailing address:
  • Phone: 479-445-6227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3585
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: