Provider Demographics
NPI:1073554051
Name:WARD, ROBERT BERNARD JR (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BERNARD
Last Name:WARD
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 OGLETHORPE AVE
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2188
Mailing Address - Country:US
Mailing Address - Phone:706-546-8407
Mailing Address - Fax:706-546-8409
Practice Address - Street 1:1500 OGLETHORPE AVE
Practice Address - Street 2:SUITE 2300
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2188
Practice Address - Country:US
Practice Address - Phone:706-546-8407
Practice Address - Fax:706-546-8409
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0080981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA19NCBQNOtherMEDICARE PTAN
GA19NCBQNOtherMEDICARE PTAN