Provider Demographics
NPI:1952050841
Name:DENNISON, JENNIFER JOYCE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JOYCE
Last Name:DENNISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JOYCE
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER BLVD
Mailing Address - Street 2:SURGERY OUTPATIENT CLINIC 5TH JANEWAY TOWER
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157
Mailing Address - Country:US
Mailing Address - Phone:336-716-0423
Mailing Address - Fax:336-716-5537
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:SURGERY OUTPATIENT CLINIC 5TH JANEWAY TOWER
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157
Practice Address - Country:US
Practice Address - Phone:336-716-0423
Practice Address - Fax:336-716-5537
Is Sole Proprietor?:No
Enumeration Date:2022-03-20
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program