Provider Demographics
NPI:1427080688
Name:WARD, TIMOTHY R (DMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:R
Last Name:WARD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830
Mailing Address - Country:US
Mailing Address - Phone:479-754-2042
Mailing Address - Fax:479-754-2429
Practice Address - Street 1:1619 W MAIN
Practice Address - Street 2:STE A
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830
Practice Address - Country:US
Practice Address - Phone:479-754-2042
Practice Address - Fax:479-754-2429
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist