Provider Demographics
NPI:1356089635
Name:WARD, JACOB BOYD (DMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:BOYD
Last Name:WARD
Suffix:
Gender:M
Credentials:DMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 SE WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-4933
Mailing Address - Country:US
Mailing Address - Phone:918-333-1576
Mailing Address - Fax:
Practice Address - Street 1:1623 SE WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-4933
Practice Address - Country:US
Practice Address - Phone:719-252-0487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK75541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice