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General NPI Number Information
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NPI Number | 1336311612
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Entity Type | Organization
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Legal Business Name | WARD ORTHODONTICS
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 857 POLK ST
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City | TWIN FALLS
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State | ID
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Zip | 83301-3985
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Country | US
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Telephone | 208-734-4314
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Fax |
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Provider Business Mailing Address
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Address Line | 857 POLK ST
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City | TWIN FALLS
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State | ID
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Zip | 83301-3985
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Country | US
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Telephone | 208-734-4314
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Fax |
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | BRIAN WARD
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Credential | DDS MSD
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Telephone | 208-734-4314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D-1385-OR
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License Number State | ID
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