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General NPI Number Information
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NPI Number | 1508621632
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Entity Type | Organization
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Legal Business Name | K. JASINSKI, D.M.D., P.C.
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 17064 US HIGHWAY 17 STE D
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City | HAMPSTEAD
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State | NC
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Zip | 28443-3303
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Country | US
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Telephone | 910-541-9290
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Fax | 910-541-9291
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Provider Business Mailing Address
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Address Line | 17064 US HIGHWAY 17 STE D
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City | HAMPSTEAD
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State | NC
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Zip | 28443-3303
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | HILLARY THULL
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Credential |
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Telephone | 217-540-8946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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