Provider Demographics
NPI:1083658553
Name:WARD, JEFFREY F (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:F
Last Name:WARD
Suffix:
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 1:4020 S 700 E
Mailing Address - Street 2:SUITE #4
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2186
Mailing Address - Country:US
Mailing Address - Phone:801-266-4352
Mailing Address - Fax:801-266-4803
Practice Address - Street 1:4020 S 700 E
Practice Address - Street 2:SUITE #4
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2186
Practice Address - Country:US
Practice Address - Phone:801-266-4352
Practice Address - Fax:801-266-4803
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT134294-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice