# J. WADE NICHOLS DMD, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851516884
- **Authorized official:** SHARON DIBENEDETTO (INS. COORD.)
- **Authorized official phone:** (843) 554-5300

## Contact information

- **Practice address:** 4605 OLEANDER DR, MYRTLE BEACH, SC 29577-5739
- **Practice address phone:** (843) 554-5300
- **Practice address fax:** (843) 554-1067
- **Mailing address:** 4605 OLEANDER DR, MYRTLE BEACH, SC 29577-5739
- **Mailing address phone:** (843) 554-5300
- **Mailing address fax:** (843) 554-1067

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | SC1956 | SC | Yes |

## Other

- **Enumeration date:** 04/16/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | SC19560 | — | SC |
| 05 | — | ZA9681 | — | SC |