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General NPI Number Information
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NPI Number | 1831282953
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Entity Type | Individual
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Provider Name | JENNIFER HOLLAND WAYER DMD
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 1860 E THREE NOTCH ST
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City | ANDALUSIA
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State | AL
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Zip | 36421-2404
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Country | US
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Telephone | 850-683-3544
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Fax | 850-683-4503
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Provider Business Mailing Address
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Address Line | 6101 STAFF RD
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City | CRESTVIEW
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State | FL
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Zip | 32536-4307
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Country | US
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Telephone | 850-902-0057
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D-0004972
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN15176
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License Number State | FL
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