Healthcare Provider Details

I. General information

NPI: 1356582480
Provider Name (Legal Business Name): RICHARD HUGH WARD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US HWY 160 AND NAVAJO RT. 135 RED MESA
TEECNOSPOS AZ
86514
US

IV. Provider business mailing address

US HWY 160 AND NAVAJO RT. 135 RED MESA
TEECNOSPOS AZ
86514
US

V. Phone/Fax

Practice location:
  • Phone: 928-656-5216
  • Fax: 928-656-5201
Mailing address:
  • Phone: 928-656-5216
  • Fax: 928-656-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number25305
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: