Healthcare Provider Details

I. General information

NPI: 1821023300
Provider Name (Legal Business Name): S. WARD ECCLES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 FENTON ST #201
LIVERMORE CA
94550-4100
US

IV. Provider business mailing address

87 FENTON ST #201
LIVERMORE CA
94550-4100
US

V. Phone/Fax

Practice location:
  • Phone: 925-447-6428
  • Fax: 925-447-6478
Mailing address:
  • Phone: 925-447-6428
  • Fax: 925-447-6478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: