Provider Demographics
NPI:1851444111
Name:JARVIS, HOWARD R (DMD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:R
Last Name:JARVIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 SW SUNSET BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2641
Mailing Address - Country:US
Mailing Address - Phone:503-244-8112
Mailing Address - Fax:503-245-4379
Practice Address - Street 1:1616 SW SUNSET BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2641
Practice Address - Country:US
Practice Address - Phone:503-244-8112
Practice Address - Fax:503-245-4379
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR57541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice