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General NPI Number Information
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NPI Number | 1275324022
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Entity Type | Individual
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Provider Name | PETER KALU DDS, MSPH
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Gender | Male
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 725 W MAIN ST
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City | JENKS
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State | OK
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Zip | 74037-3518
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Country | US
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Telephone | 202-903-4174
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Fax |
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Provider Business Mailing Address
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Address Line | 11421 S JAMES AVE APT 825
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City | JENKS
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State | OK
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Zip | 74037-1740
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Country | US
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Telephone | 202-903-4174
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8103
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License Number State | OK
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