Provider Demographics
NPI:1851351449
Name:WARD, DAVID G (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
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 1:2190 CHAMBLISS AVE NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3839
Mailing Address - Country:US
Mailing Address - Phone:423-476-3307
Mailing Address - Fax:423-476-2110
Practice Address - Street 1:2190 CHAMBLISS AVE NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3839
Practice Address - Country:US
Practice Address - Phone:423-476-3307
Practice Address - Fax:423-476-2110
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000052631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3225741Medicaid
TN145809OtherBCBS OF TENN