Provider Demographics
NPI:1902180334
Name:DR.ROBERT E.JARVIS II, A CALIFORNIA PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:DR.ROBERT E.JARVIS II, A CALIFORNIA PROFESSIONAL DENTAL CORPORATION
Other - Org Name:WINDSOR ORAL SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ELTON
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-838-8836
Mailing Address - Street 1:8741 BROOKS RD S
Mailing Address - Street 2:SUITE #101
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-7853
Mailing Address - Country:US
Mailing Address - Phone:707-838-8836
Mailing Address - Fax:707-838-1858
Practice Address - Street 1:8741 BROOKS RD S
Practice Address - Street 2:SUITE #101
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-7853
Practice Address - Country:US
Practice Address - Phone:707-838-8836
Practice Address - Fax:707-838-1858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA299561223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty