Provider Demographics
NPI:1932986395
Name:WARD, TYMARIN (RDH)
Entity Type:Individual
Prefix:
First Name:TYMARIN
Middle Name:
Last Name:WARD
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8144 HICKORY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-8640
Mailing Address - Country:US
Mailing Address - Phone:253-686-7651
Mailing Address - Fax:
Practice Address - Street 1:7581 BUCKINGHAM BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-3218
Practice Address - Country:US
Practice Address - Phone:443-863-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8749124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist