Provider Demographics
NPI:1598472102
Name:WARE FAMILY DENTAL OF MISSISSIPPI
Entity Type:Organization
Organization Name:WARE FAMILY DENTAL OF MISSISSIPPI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:601-947-9530
Mailing Address - Street 1:13 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-6095
Mailing Address - Country:US
Mailing Address - Phone:601-947-9530
Mailing Address - Fax:601-947-9595
Practice Address - Street 1:13 PLAZA DR
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-6095
Practice Address - Country:US
Practice Address - Phone:601-947-9530
Practice Address - Fax:601-947-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00273591Medicaid