Provider Demographics
NPI:1194112599
Name:CRISP, JENNIFER DURHAM (DDS, MS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DURHAM
Last Name:CRISP
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NICOLE
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:3154 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9114
Mailing Address - Country:US
Mailing Address - Phone:336-524-5439
Mailing Address - Fax:
Practice Address - Street 1:3154 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9114
Practice Address - Country:US
Practice Address - Phone:336-524-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100951223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry