Provider Demographics
NPI:1659820330
Name:JAYNE E KALU DMD PA
Entity Type:Organization
Organization Name:JAYNE E KALU DMD PA
Other - Org Name:NEW WORLD DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:EBERECHUKWU
Authorized Official - Last Name:KALU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:347-534-7416
Mailing Address - Street 1:PO BOX 620304
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-0105
Mailing Address - Country:US
Mailing Address - Phone:704-918-5560
Mailing Address - Fax:980-223-6905
Practice Address - Street 1:4995 WEDDINGTON ROAD NW
Practice Address - Street 2:SUITE 40
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-0042
Practice Address - Country:US
Practice Address - Phone:704-918-5560
Practice Address - Fax:980-223-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9616261QD0000X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1639304892OtherNPI TYPE I