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Contact Information

J. WADE NICHOLS DMD, PA
4605 OLEANDER DR
MYRTLE BEACH, SC29577-5739
 Phone: 843-554-5300
 Fax: 843-554-1067
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Endodontics

1223E0200X
Indicates primary specialty

NPI Profile & details for J. WADE NICHOLS DMD, PA

NPI Number 1851516884
LBN Legal business name J. WADE NICHOLS DMD, PA
Authorized official SHARON DIBENEDETTO - (INS. COORD.)
Entity Organization
Organization subpart 1 No
Enumeration date 04/16/2007
Last updated 08/22/2020 - About 6 years ago
Identifiers
SC License # SC1956
SC Medicaid SC19560
SC Medicaid ZA9681
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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