Provider Demographics
NPI:1336308600
Name:GILES, JENINE NICOLE (DDS)
Entity Type:Individual
Prefix:
First Name:JENINE
Middle Name:NICOLE
Last Name:GILES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 KENTWORTH DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7690
Mailing Address - Country:US
Mailing Address - Phone:919-567-7400
Mailing Address - Fax:919-567-3452
Practice Address - Street 1:12520 CAPITAL BLVD
Practice Address - Street 2:SUITE 101 AND 201
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4659
Practice Address - Country:US
Practice Address - Phone:704-301-6157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8604122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist