Provider Demographics
NPI:1790852267
Name:WARE, TAWANA KIESHAWN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAWANA
Middle Name:KIESHAWN
Last Name:WARE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TAWANA
Other - Middle Name:KIESHAWN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2050 BLUESTONE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5977
Mailing Address - Country:US
Mailing Address - Phone:636-946-5225
Mailing Address - Fax:636-946-5005
Practice Address - Street 1:11709 OLD BALLAS RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-567-1122
Practice Address - Fax:314-567-0260
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040186451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry