MEDICARE: DR. RUFUS CHARLES WARD D.D.S

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	1223G0001X	General Practice Dentistry	136783-9922	UT

General Provider Information

NPI Number	:	1437209947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUFUS CHARLES WARD D.D.S

Provider Business Mailing Address
First Line	:	575 E 4500 S STE B220
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-4515
Country	:	US
Telephone Number	:	801-261-3622
Fax Number	:	801-261-3623

Provider Business Practice Location Address
First Line	:	575 E 4500 S STE B220
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-4515
Country	:	US
Telephone Number	:	801-261-3622
Fax Number	:	801-261-3623

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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