Jennifer Jo Wade, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

9963 Issued in TN

Practice address

2953 Broad Ave
Memphis, TN 38112-2957

Phone

(901) 701-2720

NPI assigned

Apr 14, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Jennifer Perry Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1428969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476921600000",
    "number": "1275929432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2953 BROAD AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381122957",
            "telephone_number": "901-701-2720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2953 BROAD AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381122957",
            "telephone_number": "901-701-2720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE",
        "first_name": "JENNIFER",
        "middle_name": "JO",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-14",
        "last_updated": "2016-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "9963",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "30634",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "PERRY",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mardrey Alicia Wade Kiles, LPC
• Wade-Hampton Counseling & Consulting, LLC
• Veronica Wade-Hampton, M.S., LPC-MHSP, NCC
• Deanie Eilee Wade-Smith, APN, NP-C
• Hailey McKinney Wade
• Jessica Wade, APRN
• Kelly Baker Wade, CRNA
• Keshia Demyra Wade
• Lacy Wade
• Nathan Tucker Wade

• Dentist in Memphis, TN
• Providers in Memphis, TN by specialty
• Dentist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.