=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861101370
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL ALAN WARD II DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2022
-----------------------------------------------------
Last Update Date | 11/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2190 US HIGHWAY 27 N
-----------------------------------------------------
City | SEBRING
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33870-1861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-535-5705
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9832 BEAR LAKE RD
-----------------------------------------------------
City | FOREST CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32703-1929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-704-0730
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 27615
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------