MEDICARE: DR. GUADALUPE M. 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	16883	TX

General Provider Information

NPI Number	:	1457436164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUADALUPE M. WARD D.D.S.

Provider Business Mailing Address
First Line	:	4009 N MESA ST STE A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-1526
Country	:	US
Telephone Number	:	915-544-3828
Fax Number	:	915-533-1762

Provider Business Practice Location Address
First Line	:	4009 N MESA ST STE A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-1526
Country	:	US
Telephone Number	:	915-544-3828
Fax Number	:	915-533-1762

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	09/06/2007

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