Provider Demographics
NPI:1477517894
Name:CARVER, JEFFERY ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:ALAN
Last Name:CARVER
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 1:2168 MCCULLOCH BLVD
Mailing Address - Street 2:#201
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403
Mailing Address - Country:US
Mailing Address - Phone:928-855-5042
Mailing Address - Fax:928-855-1328
Practice Address - Street 1:2168 MCCULLOCH BLVD
Practice Address - Street 2:#201
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403
Practice Address - Country:US
Practice Address - Phone:928-855-5042
Practice Address - Fax:928-855-1328
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist