=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306940911
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOMAS WARD DMD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2006
-----------------------------------------------------
Last Update Date | 05/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 655 SW 20TH RD
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33129-1325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-785-5391
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 655 SW 20TH RD
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33129-1325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-785-5391
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. LUISA M UTSET-WARD
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 305-377-8004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN10987
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------