MEDICARE: DENTISTRY WITH PURPOSE

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1730067505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTISTRY WITH PURPOSE

Provider Business Mailing Address
First Line	:	6101 STAFF RD
Second Line	:
City	:	CRESTVIEW
State	:	FL
Zip	:	32536-4307
Country	:	US
Telephone Number	:	850-902-0057
Fax Number	:

Provider Business Practice Location Address
First Line	:	1860 E THREE NOTCH ST
Second Line	:
City	:	ANDALUSIA
State	:	AL
Zip	:	36421-2404
Country	:	US
Telephone Number	:	850-902-0057
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. JENNIFER HOLLAND WAYER
Credential	:	DMD
Telephone Number	:	850-902-0057

Provider Enumeration Date	:	08/21/2025
Last Update Date	:	08/21/2025

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Directions to “DENTISTRY WITH PURPOSE ” Practice Location

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