Individual
JENNIFER LAUREN DALLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9930 KINCEY AVE STE 165, HUNTERSVILLE, NC 28078-6541
(704) 947-5005
(877) 881-8455
Mailing address
204 WATERBY WAY, MATTHEWS, NC 28104-0412
(770) 335-3469
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
201500282
NC
207RH0003X
Hematology & Oncology Physician
Primary
201500282
NC
207RX0202X
Medical Oncology Physician
201500282
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003114517A
—
GA
05
—
1417046343
—
NC
Enumeration date
10/11/2006
Last updated
09/25/2025
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