Provider Demographics
NPI:1124504790
Name:WARE, ADRIENNE SMITH (DDS)
Entity type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:SMITH
Last Name:WARE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-5046
Mailing Address - Country:US
Mailing Address - Phone:985-249-8337
Mailing Address - Fax:
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
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4015-181223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1598472102OtherGROUP NPI