Provider Demographics
NPI:1215039318
Name:REED K JARVIS DDS PA
Entity Type:Organization
Organization Name:REED K JARVIS DDS PA
Other - Org Name:JARVIS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:REED
Authorized Official - Middle Name:K
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-322-8200
Mailing Address - Street 1:9460 W FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-0500
Mailing Address - Country:US
Mailing Address - Phone:208-322-8200
Mailing Address - Fax:208-322-7561
Practice Address - Street 1:9460 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709
Practice Address - Country:US
Practice Address - Phone:208-322-8200
Practice Address - Fax:208-322-7561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD15261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002420900Medicaid