Provider Demographics
NPI:1275917916
Name:ROY D JENNINGS DDS PA
Entity Type:Organization
Organization Name:ROY D JENNINGS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:D
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-649-6893
Mailing Address - Street 1:2208 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-6725
Mailing Address - Country:US
Mailing Address - Phone:704-283-2998
Mailing Address - Fax:704-283-6883
Practice Address - Street 1:2208 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-6725
Practice Address - Country:US
Practice Address - Phone:704-283-2998
Practice Address - Fax:704-283-6883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7994122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty