Provider Demographics
NPI:1205009875
Name:WARD, GERALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
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 1:5530 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1302
Mailing Address - Country:US
Mailing Address - Phone:708-424-2900
Mailing Address - Fax:708-424-6118
Practice Address - Street 1:5530 W 79TH ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1302
Practice Address - Country:US
Practice Address - Phone:708-424-2900
Practice Address - Fax:708-424-6118
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026631122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist