MEDICARE: STEPHEN G. WARD, D.D.S. DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	034572	CA

General Provider Information

NPI Number	:	1306145966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN G. WARD, D.D.S. DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	3500 FIFTH AVE STE 201
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5020
Country	:	US
Telephone Number	:	619-298-2893
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 FIFTH AVE STE 201
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5020
Country	:	US
Telephone Number	:	619-298-2893
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHEN G WARD
Credential	:	D.D.S.
Telephone Number	:	619-298-2893

Provider Enumeration Date	:	03/22/2011
Last Update Date	:	03/22/2011

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