Provider Demographics
NPI:1083787576
Name:WARD, ROBERT L (DDS,PA)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:WARD
Suffix:
Gender:M
Credentials:DDS,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5249
Mailing Address - Country:US
Mailing Address - Phone:479-452-8193
Mailing Address - Fax:479-452-5720
Practice Address - Street 1:9000 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5249
Practice Address - Country:US
Practice Address - Phone:479-452-8193
Practice Address - Fax:479-452-5720
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR25621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR2562OtherLICENSE
AR39024OtherUNITED CONCORDIA
AR58955OtherBCBS