MEDICARE: DR. JENNIFER HOLLAND WAYER DMD

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	1223G0001X	General Practice Dentistry	D-0004972	AL
2	122300000X	Dentist	DN15176	FL

General Provider Information

NPI Number	:	1831282953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER HOLLAND WAYER DMD

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	:	850-683-3544
Fax Number	:	850-683-4503

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	08/21/2025

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