Provider Demographics
NPI:1669502753
Name:WARD, MICHAEL RICKY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RICKY
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 1:375 BULLARD AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1056
Mailing Address - Country:US
Mailing Address - Phone:559-298-7424
Mailing Address - Fax:559-298-7015
Practice Address - Street 1:375 BULLARD AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1056
Practice Address - Country:US
Practice Address - Phone:559-298-7424
Practice Address - Fax:559-298-7015
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA. 282531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB28253-01Medicaid