Jennifer Boyland Wade, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8333 Issued in SC

Practice address

2090 Charlie Hall Blvd Ste 100
Charleston, SC 29414-8200

Phone

(437) 667-1318

NPI assigned

Mar 28, 2017

Last updated

Sep 23, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Jennifer Leigh Boyland Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 29, 2021 through Apr 29, 2027

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1490659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632355200000",
    "number": "1891227096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 DOUGHTY ST",
            "address_2": "APT. A",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294035858",
            "telephone_number": "540-230-1237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2090 CHARLIE HALL BLVD STE 100",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294148200",
            "telephone_number": "437-667-1318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE",
        "first_name": "JENNIFER",
        "middle_name": "BOYLAND",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-28",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "8333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "BOYLAND",
            "middle_name": "LEIGH",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Wade Family Dentistry LLC (Moore Family Dentistry)
• Allison Marie Wade, PA-C
• Dianne Leblanc Wade, R.D.
• Donald F Wade, M.D.
• Graham Clarkson Wade, PT
• Jessica Feltracco Wade
• Kathryn Anne Wade, PA
• Kistricia Breyanna Wade, CNA
• Lakosha T Wade, NP
• Mason Wade, D.M.D.

• General Practice Dentistry in Charleston, SC
• Providers in Charleston, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.