Provider Demographics
NPI:1205394715
Name:WARD, TYROUS DAVID (PHD, DDS)
Entity Type:Individual
Prefix:DR
First Name:TYROUS
Middle Name:DAVID
Last Name:WARD
Suffix:
Gender:M
Credentials:PHD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4354 ALDENHAM WAY
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4014
Mailing Address - Country:US
Mailing Address - Phone:770-900-2831
Mailing Address - Fax:
Practice Address - Street 1:AUGUSTA UNIVERSITY, THE DENTAL COLLEGE OF GEORGIA
Practice Address - Street 2:1120 15TH STREET, GC 5110
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0001
Practice Address - Country:US
Practice Address - Phone:706-721-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6983390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6983OtherLOUISIANA STATE BOARD OF DENTISTRY