Provider Demographics
NPI:1073770665
Name:TARVER, JUSTIN E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:E
Last Name:TARVER
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 1:92 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-4262
Mailing Address - Country:US
Mailing Address - Phone:318-343-6006
Mailing Address - Fax:
Practice Address - Street 1:92 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-4262
Practice Address - Country:US
Practice Address - Phone:318-343-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA58781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice