MEDICARE: DR. JODIE KEVIN WARD DDS

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	3109	WV

General Provider Information

NPI Number	:	1922150457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JODIE KEVIN WARD DDS

Provider Business Mailing Address
First Line	:	71 COWARDLY LION DR SUITE C
Second Line	:
City	:	HEDGESVILLE
State	:	WV
Zip	:	25427-6779
Country	:	US
Telephone Number	:	304-754-9008
Fax Number	:	304-754-0098

Provider Business Practice Location Address
First Line	:	71 COWARDLY LION DR STE C
Second Line	:
City	:	HEDGESVILLE
State	:	WV
Zip	:	25427-6779
Country	:	US
Telephone Number	:	304-754-9008
Fax Number	:	304-754-0098

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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