Healthcare Provider Details

I. General information

NPI: 1386579704
Provider Name (Legal Business Name): JASMINE LENEIGH DENNIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 VAUGHN RD # 2800
BURLINGTON NC
27217-2863
US

IV. Provider business mailing address

299 LLOYD ST
CARRBORO NC
27510-1821
US

V. Phone/Fax

Practice location:
  • Phone: 336-506-5840
  • Fax:
Mailing address:
  • Phone: 919-933-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number14789
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: