Provider Demographics
NPI:1548202039
Name:REVOIR, JEFF HAROLD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:HAROLD
Last Name:REVOIR
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 1:3490 S POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2908
Mailing Address - Country:US
Mailing Address - Phone:303-758-2980
Mailing Address - Fax:303-756-8551
Practice Address - Street 1:3490 S POPLAR ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-2908
Practice Address - Country:US
Practice Address - Phone:303-758-2980
Practice Address - Fax:303-756-8551
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN-105666122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist