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Organization
J. WADE NICHOLS DMD, PA
Active
Organization
J. WADE NICHOLS DMD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON DIBENEDETTO (INS. COORD.)
(843) 554-5300
Entity
Organization
Contact information
Practice address
4605 OLEANDER DR, MYRTLE BEACH, SC 29577-5739
(843) 554-5300
(843) 554-1067
Mailing address
4605 OLEANDER DR, MYRTLE BEACH, SC 29577-5739
(843) 554-5300
(843) 554-1067
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
SC1956
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SC19560
—
SC
05
—
ZA9681
—
SC
Enumeration date
04/16/2007
Last updated
08/22/2020
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