Provider Demographics
NPI:1588778302
Name:WARD, JON D
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:D
Last Name:WARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 E THREE NOTCH ST
Mailing Address - Street 2:STE E
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-3167
Mailing Address - Country:US
Mailing Address - Phone:334-222-4222
Mailing Address - Fax:334-222-7456
Practice Address - Street 1:406 E THREE NOTCH ST
Practice Address - Street 2:STE E
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-3167
Practice Address - Country:US
Practice Address - Phone:334-222-4222
Practice Address - Fax:334-222-7456
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL42071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0187306OtherBLUE CROSS OF TN
AL823268OtherTRICARE PROVIDER #
AL510-90519OtherBLUE CROSS OF AL