1225284433 NPI number — DR. TERRANCE LEMOND WARE D.D.S.

Table of content: DR. TERRANCE LEMOND WARE D.D.S. (NPI 1225284433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225284433 NPI number — DR. TERRANCE LEMOND WARE D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARE
Provider First Name:
TERRANCE
Provider Middle Name:
LEMOND
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225284433
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1025
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRYSTAL SPRINGS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39059-1025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-892-1904
Provider Business Mailing Address Fax Number:
601-647-1333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 HARMONY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRYSTAL SPRINGS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39059-2809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-892-1904
Provider Business Practice Location Address Fax Number:
601-647-1333
Provider Enumeration Date:
08/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  3439-07 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: DS0000008594 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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