Provider Demographics
NPI:1609098656
Name:KARVANDI, JEFFREY J (DMD,MS,PLLC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:KARVANDI
Suffix:
Gender:M
Credentials:DMD,MS,PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 W SUSSEX AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6834
Mailing Address - Country:US
Mailing Address - Phone:406-728-4032
Mailing Address - Fax:406-728-7380
Practice Address - Street 1:705 WEST SUSSEX AVENUE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801
Practice Address - Country:US
Practice Address - Phone:406-728-4032
Practice Address - Fax:406-728-7380
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT21381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2138OtherLICENCE NUMBER
MT20-8069166OtherTAX ID NUMBER