Provider Demographics
NPI:1912958901
Name:KALONS, JOHANNA SHUBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:SHUBERT
Last Name:KALONS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S COLLEGE ST
Mailing Address - Street 2:SUITE 1465
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28244-0002
Mailing Address - Country:US
Mailing Address - Phone:704-378-6591
Mailing Address - Fax:704-378-6594
Practice Address - Street 1:201 S COLLEGE ST
Practice Address - Street 2:SUITE 1465
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28244-0002
Practice Address - Country:US
Practice Address - Phone:704-378-6591
Practice Address - Fax:704-378-6594
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist