Provider Demographics
NPI:1487813671
Name:JARAVAZA, SIMBARASHE (DDS, MS)
Entity Type:Individual
Prefix:
First Name:SIMBARASHE
Middle Name:
Last Name:JARAVAZA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 GRANVILLE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-6201
Mailing Address - Country:US
Mailing Address - Phone:252-353-5729
Mailing Address - Fax:
Practice Address - Street 1:310 GRANVILLE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-6201
Practice Address - Country:US
Practice Address - Phone:252-353-5729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6195122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist