Healthcare Provider Details

I. General information

NPI: 1720991375
Provider Name (Legal Business Name): K. JASINSKI, D.M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7439 ROCKFISH RD
FAYETTEVILLE NC
28306-8075
US

IV. Provider business mailing address

7439 ROCKFISH RD
FAYETTEVILLE NC
28306-8075
US

V. Phone/Fax

Practice location:
  • Phone: 472-263-2530
  • Fax: 472-263-2539
Mailing address:
  • Phone: 472-263-2530
  • Fax: 472-263-2539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CEMYIRA MCDOUGAL
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 217-764-8609