Healthcare Provider Details

I. General information

NPI: 1891964227
Provider Name (Legal Business Name): JENNIFER S. MASSEY, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1064 SEVEN LAKES DRIVE
WEST END NC
27376
US

IV. Provider business mailing address

6513 SEVEN LAKES VLG
WEST END NC
27376-9300
US

V. Phone/Fax

Practice location:
  • Phone: 910-673-6030
  • Fax: 910-673-6031
Mailing address:
  • Phone: 910-673-6030
  • Fax: 910-673-6031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER STALLINGS MASSEY
Title or Position: PRESIDENT
Credential: DDS
Phone: 910-673-6030