=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386579704
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASMINE LENEIGH DENNIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2026
-----------------------------------------------------
Last Update Date | 06/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1214 VAUGHN RD # 2800
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27217-2863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-506-5840
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 299 LLOYD ST
-----------------------------------------------------
City | CARRBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27510-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-933-8494
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223D0001X
-----------------------------------------------------
Taxonomy Name | Public Health Dentistry
-----------------------------------------------------
License Number | 14789
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------