MEDICARE: TERRANCE WARE DDS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	3439-07	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710391545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRANCE WARE DDS, PLLC

Provider Business Mailing Address
First Line	:	5800 RIDGEWOOD RD
Second Line	:	SUITE 104
City	:	JACKSON
State	:	MS
Zip	:	39211-2667
Country	:	US
Telephone Number	:	601-892-1904
Fax Number	:	601-647-1333

Provider Business Practice Location Address
First Line	:	5800 RIDGEWOOD RD
Second Line	:	SUITE 104
City	:	JACKSON
State	:	MS
Zip	:	39211-2667
Country	:	US
Telephone Number	:	601-892-1904
Fax Number	:	601-647-1333

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	DR. TERRANCE LEMOND WARE
Credential	:	DDS
Telephone Number	:	601-892-1904

Provider Enumeration Date	:	06/19/2014
Last Update Date	:	06/19/2014

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