MEDICARE: DR. KEVIN D 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	12008832	IN

General Provider Information

NPI Number	:	1750478533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN D WARD D.D.S.

Provider Business Mailing Address
First Line	:	11959 LAKESIDE DRIVE
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-1316
Country	:	US
Telephone Number	:	317-577-1911
Fax Number	:	317-576-8070

Provider Business Practice Location Address
First Line	:	11959 LAKESIDE DR
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-1316
Country	:	US
Telephone Number	:	317-577-1911
Fax Number	:	317-576-8070

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	05/28/2026

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