Provider Demographics
NPI:1306940911
Name:THOMAS WARD DMD
Entity type:Organization
Organization Name:THOMAS WARD DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:UTSET-WARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-377-8004
Mailing Address - Street 1:655 SW 20TH RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-1325
Mailing Address - Country:US
Mailing Address - Phone:305-785-5391
Mailing Address - Fax:
Practice Address - Street 1:655 SW 20TH RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129-1325
Practice Address - Country:US
Practice Address - Phone:305-785-5391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10987122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL071140300Medicaid