Healthcare Provider Details

I. General information

NPI: 1922932896
Provider Name (Legal Business Name): ALYSSA MARIE WARE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17965 US HIGHWAY 64
SOMERVILLE TN
38068-6906
US

IV. Provider business mailing address

17965 US HIGHWAY 64
SOMERVILLE TN
38068-6906
US

V. Phone/Fax

Practice location:
  • Phone: 901-466-8295
  • Fax:
Mailing address:
  • Phone: 901-466-8295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13247
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: