Provider Demographics
NPI:1467167262
Name:DR. KEVIN JALALI PLLC
Entity Type:Organization
Organization Name:DR. KEVIN JALALI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JALALI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-237-0507
Mailing Address - Street 1:1818 LOMBARDY CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6056
Mailing Address - Country:US
Mailing Address - Phone:704-237-0507
Mailing Address - Fax:
Practice Address - Street 1:1818 LOMBARDY CIR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6056
Practice Address - Country:US
Practice Address - Phone:704-237-0507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental