Provider Demographics
NPI:1194454918
Name:JERNIGAN, EMILY HODGIN (DMD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:HODGIN
Last Name:JERNIGAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:WALKER
Other - Last Name:HODGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:720 KIMBROUGH ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-2724
Mailing Address - Country:US
Mailing Address - Phone:336-413-9568
Mailing Address - Fax:
Practice Address - Street 1:8450 LOUISBURG RD STE 130
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-5884
Practice Address - Country:US
Practice Address - Phone:919-266-5332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC127861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice