Provider Demographics
NPI:1528087871
Name:WARD, TASHA P (DDS)
Entity type:Individual
Prefix:DR
First Name:TASHA
Middle Name:P
Last Name:WARD
Suffix:
Gender:F
Credentials:DDS
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 389
Mailing Address - Street 2:
Mailing Address - City:TALLEVAST
Mailing Address - State:FL
Mailing Address - Zip Code:34270-0389
Mailing Address - Country:US
Mailing Address - Phone:941-355-4800
Mailing Address - Fax:941-355-4060
Practice Address - Street 1:1619 TALLEVAST ROAD
Practice Address - Street 2:
Practice Address - City:TALLEVAST
Practice Address - State:FL
Practice Address - Zip Code:34270
Practice Address - Country:US
Practice Address - Phone:941-355-4800
Practice Address - Fax:941-355-4060
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17405122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0197865-00Medicaid
FL0762377-00Medicaid