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NPI Code Detail

MEDICARE: MR. CRAIG S WARD LD

MEDICARE: MR. CRAIG S WARD LD
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
1122400000XDenturistDT-DO-10195126OR

General Provider Information

NPI Number : 1831752823
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CRAIG S WARD LD
Provider Business Mailing Address
First Line : PO BOX 11470
Second Line :
City : EUGENE
State : OR
Zip : 97440-3670
Country : US
Telephone Number : 888-468-0022
Fax Number :
Provider Business Practice Location Address
First Line : 521 N 1ST AVE
Second Line :
City : STAYTON
State : OR
Zip : 97383-1703
Country : US
Telephone Number : 503-769-9699
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2019
Last Update Date : 04/16/2019

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