Provider Demographics
NPI:1295848190
Name:JARVIS, REED K (DDS)
Entity type:Individual
Prefix:DR
First Name:REED
Middle Name:K
Last Name:JARVIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:REED
Other - Middle Name:
Other - Last Name:JARVIS
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-1387
Mailing Address - Country:US
Mailing Address - Phone:208-415-0299
Mailing Address - Fax:208-625-2070
Practice Address - Street 1:1090 W PARK PL STE B
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2785
Practice Address - Country:US
Practice Address - Phone:208-292-0697
Practice Address - Fax:208-292-0357
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-15261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002420900Medicaid
ID1526OtherIDAHO STATE DENTAL LICENSE