Healthcare Provider Details

I. General information

NPI: 1124504790
Provider Name (Legal Business Name): ADRIENNE SMITH WARE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 PLAZA DR
LUCEDALE MS
39452-6095
US

IV. Provider business mailing address

2525 TIMBER LN
LUCEDALE MS
39452-5046
US

V. Phone/Fax

Practice location:
  • Phone: 601-947-9530
  • Fax: 601-947-9595
Mailing address:
  • Phone: 985-249-8337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4015-18
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4015-18
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: