Healthcare Provider Details

I. General information

NPI: 1396613600
Provider Name (Legal Business Name): JADED JOY ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7940 PARK RD
CHARLOTTE NC
28210-6728
US

IV. Provider business mailing address

7940 PARK RD
CHARLOTTE NC
28210-6728
US

V. Phone/Fax

Practice location:
  • Phone: 844-628-2388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: NIKKI BAILEY
Title or Position: MEDICAL DIRECTOR
Credential: DDS
Phone: 844-628-2388