Healthcare Provider Details

I. General information

NPI: 1649521097
Provider Name (Legal Business Name): NATHAN W. WARD, DDS, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 ALEXANDER ST
WATSONVILLE CA
95076-4609
US

IV. Provider business mailing address

24 ALEXANDER ST
WATSONVILLE CA
95076-4609
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-0232
  • Fax:
Mailing address:
  • Phone: 831-728-0232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number59615
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number59615
License Number StateCA

VIII. Authorized Official

Name: DR. NATHAN W WARD
Title or Position: OWNER
Credential: DDS
Phone: 831-728-0232