Provider Demographics
NPI:1508435199
Name:WARD, ALEX MCCREARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:MCCREARY
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 1:608 SANFORD RD
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-4126
Mailing Address - Country:US
Mailing Address - Phone:334-488-1056
Mailing Address - Fax:
Practice Address - Street 1:740 SOUTH LIMESTONE A219
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-2960
Practice Address - Country:US
Practice Address - Phone:859-323-3368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD-0006911-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY10784OtherKENTUCKY BOARD OF DENTISTRY