Provider Demographics
NPI:1831282953
Name:WAYER, JENNIFER HOLLAND (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:HOLLAND
Last Name:WAYER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 STAFF RD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-4307
Mailing Address - Country:US
Mailing Address - Phone:850-902-0057
Mailing Address - Fax:
Practice Address - Street 1:1860 E THREE NOTCH ST
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36421-2404
Practice Address - Country:US
Practice Address - Phone:850-683-3544
Practice Address - Fax:850-683-4503
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD-00049721223G0001X
FLDN15176122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist