Provider Demographics
NPI:1023116225
Name:WARD, ROBERT PHILIP (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:PHILIP
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 1:15515 3RD AVE SW
Mailing Address - Street 2:STE B
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98166
Mailing Address - Country:US
Mailing Address - Phone:206-242-8600
Mailing Address - Fax:206-248-2464
Practice Address - Street 1:15515 3RD AVE SW
Practice Address - Street 2:STE B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98166
Practice Address - Country:US
Practice Address - Phone:206-242-8600
Practice Address - Fax:206-248-2464
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000041531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice