Provider Demographics
NPI:1134346349
Name:WARD, CLABARA (DDS)
Entity type:Individual
Prefix:DR
First Name:CLABARA
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CANDY
Other - Middle Name:
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1500 SHADYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-5630
Mailing Address - Country:US
Mailing Address - Phone:903-572-5505
Mailing Address - Fax:
Practice Address - Street 1:1500 SHADYWOOD LN
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-5630
Practice Address - Country:US
Practice Address - Phone:903-572-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX158701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice