Healthcare Provider Details

I. General information

NPI: 1437183001
Provider Name (Legal Business Name): ELIZABETH A WARD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 R.D. MIZE ROAD
GRAIN VALLEY MO
64029
US

IV. Provider business mailing address

655 R.D. MIZE ROAD
GRAIN VALLEY MO
64029
US

V. Phone/Fax

Practice location:
  • Phone: 816-229-4560
  • Fax: 816-229-1849
Mailing address:
  • Phone: 816-229-4560
  • Fax: 816-229-1849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13532
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: