Provider Demographics
NPI:1073687802
Name:JENNIFER H WAYER DMD PA
Entity Type:Organization
Organization Name:JENNIFER H WAYER DMD PA
Other - Org Name:CRESTVIEW FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:H
Authorized Official - Last Name:WAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-683-3544
Mailing Address - Street 1:502 E HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536
Mailing Address - Country:US
Mailing Address - Phone:850-683-3544
Mailing Address - Fax:850-683-4503
Practice Address - Street 1:502 E HICKORY AVE
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536
Practice Address - Country:US
Practice Address - Phone:850-683-3544
Practice Address - Fax:850-683-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15176122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty