Provider Demographics
NPI:1932546157
Name:ELMORE, JASMINE RENEE (DDS)
Entity type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:RENEE
Last Name:ELMORE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4049 LANDOVER PEAK PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-9796
Mailing Address - Country:US
Mailing Address - Phone:252-916-5875
Mailing Address - Fax:
Practice Address - Street 1:2401 WOOTEN BLVD SW
Practice Address - Street 2:SUITE F
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-291-4300
Practice Address - Fax:252-291-2337
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC95961223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program