Provider Demographics
NPI:1215261532
Name:RYAN D. WARD,D.D.S.LLC
Entity type:Organization
Organization Name:RYAN D. WARD,D.D.S.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-387-6222
Mailing Address - Street 1:3050 FORSYTHE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3012
Mailing Address - Country:US
Mailing Address - Phone:318-387-6222
Mailing Address - Fax:318-387-1244
Practice Address - Street 1:3050 FORSYTHE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3012
Practice Address - Country:US
Practice Address - Phone:318-387-6222
Practice Address - Fax:318-387-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5379122300000X
LA5975122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1853798Medicaid
LA1859753Medicaid