Provider Demographics
NPI:1497020770
Name:WARD, L. STEPHEN
Entity Type:Individual
Prefix:DR
First Name:L.
Middle Name:STEPHEN
Last Name:WARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3970 N 86TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2861
Mailing Address - Country:US
Mailing Address - Phone:414-464-6820
Mailing Address - Fax:414-464-6820
Practice Address - Street 1:3970 N 86TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-2861
Practice Address - Country:US
Practice Address - Phone:414-464-6820
Practice Address - Fax:414-464-6820
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50012501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice