NPIMap

Organization Active NPI

J. Wade Nichols DMD, PA

  • Endodontics
  • Myrtle Beach, SC
National Provider Identifier
1851516884
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
SC1956 Issued in SC
Legal business name
J. WADE NICHOLS DMD, PA
Practice address
4605 Oleander Dr
Myrtle Beach, SC 29577-5739
Phone
(843) 554-5300
Fax
(843) 554-1067
NPI assigned
Apr 16, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Sharon Dibenedetto
Title
Ins. Coord.
Phone
(843) 554-5300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X SC1956 SC Primary

Addresses

Primary practice location

4605 Oleander Dr
Myrtle Beach, SC 29577-5739

Mailing address

4605 Oleander Dr
Myrtle Beach, SC 29577-5739
Phone (843) 554-5300

Other identifiers 2

IdentifierTypeStateIssuer
SC19560MedicaidSC
ZA9681MedicaidSC

National Provider Directory

National Provider Directory

Locations

4605 Oleander Dr
Myrtle Beach, SC 29577
Phone (843) 554-5300

NPI Registry JSON

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851516884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4605 OLEANDER DR",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295775739",
            "telephone_number": "843-554-5300",
            "fax_number": "843-554-1067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 OLEANDER DR",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295775739",
            "telephone_number": "843-554-5300",
            "fax_number": "843-554-1067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J. WADE NICHOLS DMD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DIBENEDETTO",
        "authorized_official_first_name": "SHARON",
        "authorized_official_title_or_position": "INS. COORD.",
        "authorized_official_telephone_number": "843-554-5300"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "SC",
            "license": "SC1956",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SC19560",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9681",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.