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General NPI Number Information
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NPI Number | 1891227096
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Entity Type | Individual
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Provider Name | JENNIFER BOYLAND WADE D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 2090 CHARLIE HALL BLVD STE 100
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City | CHARLESTON
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State | SC
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Zip | 29414-8200
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Country | US
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Telephone | 437-667-1318
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Fax |
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Provider Business Mailing Address
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Address Line | 6 DOUGHTY ST APT. A
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City | CHARLESTON
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State | SC
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Zip | 29403-5858
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Country | US
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Telephone | 540-230-1237
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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 | 8333
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License Number State | SC
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