Healthcare Provider Details

I. General information

NPI: 1609337930
Provider Name (Legal Business Name): JEAN KONTOS GINNIS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MANNING DRIVE & S COLUMBIA STREET
CHAPEL HILL NC
27599-0001
US

IV. Provider business mailing address

MANNING DRIVE & S COLUMBIA STREET BRAUER 236
CHAPEL HILL NC
27599-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-537-3211
  • Fax:
Mailing address:
  • Phone: 919-537-3782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number00187
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12578
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: