Provider Demographics
NPI:1902575079
Name:WARE, IAN (DMD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:WARE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 GREENVALE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1118
Mailing Address - Country:US
Mailing Address - Phone:614-441-5329
Mailing Address - Fax:
Practice Address - Street 1:NMRTC PORTSMOUTH
Practice Address - Street 2:620 JOHN PAUL JONES
Practice Address - City:PORTSMOUTH
Practice Address - State:AE
Practice Address - Zip Code:23708
Practice Address - Country:US
Practice Address - Phone:757-953-7133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.026604122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist