Provider Demographics
NPI:1952504318
Name:JARIVS, JACOB REED (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:REED
Last Name:JARIVS
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6000 S QUAMASH WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-5617
Mailing Address - Country:US
Mailing Address - Phone:208-383-0100
Mailing Address - Fax:208-321-5507
Practice Address - Street 1:6000 S QUAMASH WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-5617
Practice Address - Country:US
Practice Address - Phone:208-383-0100
Practice Address - Fax:208-321-5507
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3999-OR1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics