Provider Demographics
NPI:1356382089
Name:KALOLA, JAY N (DDS)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:N
Last Name:KALOLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W FAIRMONT ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-1021
Mailing Address - Country:US
Mailing Address - Phone:610-435-1288
Mailing Address - Fax:610-435-5451
Practice Address - Street 1:1414 W FAIRMONT ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-1021
Practice Address - Country:US
Practice Address - Phone:610-435-1288
Practice Address - Fax:610-435-5451
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0202341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice