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General NPI Number Information
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NPI Number | 1417046343
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Entity Type | Individual
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Provider Name | JENNIFER LAUREN DALLAS MD
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Gender | Female
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 9930 KINCEY AVE STE 165
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-6541
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Country | US
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Telephone | 704-947-5005
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Fax | 877-881-8455
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Provider Business Mailing Address
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Address Line | 204 WATERBY WAY
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City | MATTHEWS
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State | NC
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Zip | 28104-0412
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Country | US
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Telephone | 770-335-3469
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 201500282
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 201500282
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 201500282
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License Number State | NC
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