Provider Demographics
NPI:1073025177
Name:MASSEY, WARD LEVINGSTON (BDS PHD)
Entity Type:Individual
Prefix:PROF
First Name:WARD
Middle Name:LEVINGSTON
Last Name:MASSEY
Suffix:
Gender:M
Credentials:BDS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 W BALTIMORE ST RM 3-201
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1510
Mailing Address - Country:US
Mailing Address - Phone:410-706-0741
Mailing Address - Fax:
Practice Address - Street 1:650 W BALTIMORE ST RM 3-201
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1510
Practice Address - Country:US
Practice Address - Phone:410-706-0741
Practice Address - Fax:410-706-0741
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice