Provider Demographics
NPI:1932932308
Name:J ELMORE DDS PLLC
Entity type:Organization
Organization Name:J ELMORE DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, CSOM, PDBSC
Authorized Official - Phone:984-689-9024
Mailing Address - Street 1:2920 FORESTVILLE RD # 100-31
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-8774
Mailing Address - Country:US
Mailing Address - Phone:252-916-5875
Mailing Address - Fax:
Practice Address - Street 1:51 KILMAYNE DR STE 203
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-7719
Practice Address - Country:US
Practice Address - Phone:984-689-9024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty