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General NPI Number Information
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NPI Number | 1982259206
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Entity Type | Individual
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Provider Name | RYAN LOGAN WARD DMD
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Gender | Male
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Dates
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Enumeration Date | 08/04/2019
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Last Update Date | 08/20/2019
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Provider Practice Location Address
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Address Line | 1901 23RD AVE
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City | MERIDIAN
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State | MS
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Zip | 39301-3108
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Country | US
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Telephone | 601-483-4371
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Fax |
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Provider Business Mailing Address
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Address Line | 3219 MINNOW BUCKET RD
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City | TOOMSUBA
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State | MS
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Zip | 39364-9732
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Country | US
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Telephone | 601-207-0060
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4086-19
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License Number State | MS
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