Provider Demographics
NPI:1548431836
Name:CROWLEY JARVIS, COLLEEN M (DDS)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:CROWLEY JARVIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 W CAYUSE CREEK
Mailing Address - Street 2:JARVIS DENTAL STE 150
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646
Mailing Address - Country:US
Mailing Address - Phone:208-888-0900
Mailing Address - Fax:208-888-0950
Practice Address - Street 1:1508 WEST CAYUSE CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646
Practice Address - Country:US
Practice Address - Phone:208-888-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD39951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice