Provider Demographics
NPI:1639261431
Name:WARD, MICHAEL TIMOTHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TIMOTHY
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 1:3906 STONEGATE PARK
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9145
Mailing Address - Country:US
Mailing Address - Phone:269-428-2875
Mailing Address - Fax:269-428-4461
Practice Address - Street 1:3906 STONEGATE PARK
Practice Address - Street 2:SUITE B
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9145
Practice Address - Country:US
Practice Address - Phone:269-428-2875
Practice Address - Fax:269-428-4461
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010136601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice