Provider Demographics
NPI:1629198494
Name:STEVEN H JAYNES DDS PA
Entity Type:Organization
Organization Name:STEVEN H JAYNES DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:JAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-365-6650
Mailing Address - Street 1:6725 B FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210
Mailing Address - Country:US
Mailing Address - Phone:704-365-6650
Mailing Address - Fax:704-365-4978
Practice Address - Street 1:6725 B FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210
Practice Address - Country:US
Practice Address - Phone:704-365-6650
Practice Address - Fax:704-365-4978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4912122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty