Provider Demographics
NPI:1710391545
Name:TERRANCE WARE DDS, PLLC
Entity Type:Organization
Organization Name:TERRANCE WARE DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:LEMOND
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:601-892-1904
Mailing Address - Street 1:5800 RIDGEWOOD RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2667
Mailing Address - Country:US
Mailing Address - Phone:601-892-1904
Mailing Address - Fax:601-647-1333
Practice Address - Street 1:5800 RIDGEWOOD RD
Practice Address - Street 2:SUITE 104
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-2667
Practice Address - Country:US
Practice Address - Phone:601-892-1904
Practice Address - Fax:601-647-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3439-07122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06932593Medicaid