MEDICARE: DR. WARD WILLIAM CLEMMONS D.D.S., P.A.

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	122300000X	Dentist	2820	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2820	OTHER	AR	LICENSE #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	71-0751372	OTHER	AR	TAX ID #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417052945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WARD WILLIAM CLEMMONS D.D.S., P.A.

Provider Business Mailing Address
First Line	:	3600 OLD GREENWOOD RD
Second Line	:	SUITE 2
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5929
Country	:	US
Telephone Number	:	479-434-6894
Fax Number	:	479-434-6896

Provider Business Practice Location Address
First Line	:	3600 OLD GREENWOOD RD
Second Line	:	SUITE 2
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5929
Country	:	US
Telephone Number	:	479-434-6894
Fax Number	:	479-434-6896

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/31/2013

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Directions to “ DR. WARD WILLIAM CLEMMONS D.D.S., P.A.” Practice Location

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