Provider Demographics
NPI:1386856615
Name:WARD, CLIFFORD BILLY (DDS)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:BILLY
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:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:TALLEVAST
Mailing Address - State:FL
Mailing Address - Zip Code:34270-0046
Mailing Address - Country:US
Mailing Address - Phone:941-355-4800
Mailing Address - Fax:941-355-4060
Practice Address - Street 1:1619 TALLEVAST RD
Practice Address - Street 2:
Practice Address - City:TALLEVAST
Practice Address - State:FL
Practice Address - Zip Code:34270
Practice Address - Country:US
Practice Address - Phone:941-355-4800
Practice Address - Fax:941-355-4060
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5019122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL073659700Medicaid