Provider Demographics
NPI:1154588481
Name:JEFFREY M. WARD
Entity type:Organization
Organization Name:JEFFREY M. WARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:479-442-6995
Mailing Address - Street 1:3089 E MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4385
Mailing Address - Country:US
Mailing Address - Phone:479-442-6995
Mailing Address - Fax:479-443-6468
Practice Address - Street 1:3089 E MISSION BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4385
Practice Address - Country:US
Practice Address - Phone:479-442-6995
Practice Address - Fax:479-443-6468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR35851223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty