Provider Demographics
NPI:1922369354
Name:JALALI, KEVIN (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:JALALI
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 1:1818 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:704-727-7500
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:704-727-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC92991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice