Provider Demographics
NPI:1356582480
Name:WARD, RICHARD HUGH (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HUGH
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:US HWY 160 AND NAVAJO RT. 135
Mailing Address - Street 2:RED MESA
Mailing Address - City:TEECNOSPOS
Mailing Address - State:AZ
Mailing Address - Zip Code:86514
Mailing Address - Country:US
Mailing Address - Phone:928-656-5216
Mailing Address - Fax:928-656-5201
Practice Address - Street 1:US HWY 160 AND NAVAJO RT. 135
Practice Address - Street 2:RED MESA
Practice Address - City:TEECNOSPOS
Practice Address - State:AZ
Practice Address - Zip Code:86514
Practice Address - Country:US
Practice Address - Phone:928-656-5216
Practice Address - Fax:928-656-5201
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA25305OtherDENTAL LICENSE