Provider Demographics
NPI:1750478533
Name:WARD, KEVIN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:D
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 1:11959 LAKESIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1316
Mailing Address - Country:US
Mailing Address - Phone:317-577-1911
Mailing Address - Fax:317-576-8070
Practice Address - Street 1:11959 LAKESIDE DRIVE
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1316
Practice Address - Country:US
Practice Address - Phone:317-577-1911
Practice Address - Fax:317-576-8070
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120088321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice