Provider Demographics
NPI:1336283571
Name:WARD, JEREMY ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:ROBERT
Last Name:WARD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2463 HAMILTON MILL PKWY
Mailing Address - Street 2:SUITE 240
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4648
Mailing Address - Country:US
Mailing Address - Phone:770-945-4445
Mailing Address - Fax:770-271-2736
Practice Address - Street 1:2463 HAMILTON MILL PKWY
Practice Address - Street 2:SUITE 240
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4648
Practice Address - Country:US
Practice Address - Phone:770-945-4445
Practice Address - Fax:770-271-2736
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0117291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice