Tasha P Ward, DDS
Individual provider Active NPI Dentist · Tallevast, FL
NPI 1528087871 · NPPES record last updated Oct 1, 2019
Key facts
- NPI
- 1528087871
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN17405 (FL)
- Practice address
- 1619 Tallevast Road
Tallevast, FL 34270 - Phone
- (941) 355-4800
- Fax
- (941) 355-4060
- NPI assigned
- Jul 18, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN17405 | FL | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN17405 | FL | Yes |
Addresses
Primary practice location
1619 Tallevast Road
Tallevast, FL 34270
Mailing address
PO Box 389
Tallevast, FL 34270-0389
Phone (941) 355-4800
Other practice location 1
204 E Palmetto St
Wauchula, FL 33873
Phone (863) 773-2111
Other practice location 2
204 E Palmetto St
Wauchula, FL 33873
Phone (863) 773-2111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0197865-00 | Medicaid | FL | |
| 0762377-00 | Medicaid | FL |
Other providers in Tallevast, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.