Provider Demographics
NPI:1245562891
Name:MONROE, STEVEN JARVIS (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JARVIS
Last Name:MONROE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 W. BROADWAY BLVD.
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760
Mailing Address - Country:US
Mailing Address - Phone:865-475-7901
Mailing Address - Fax:865-475-8133
Practice Address - Street 1:156 W. BROADWAY BLVD.
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760
Practice Address - Country:US
Practice Address - Phone:865-475-7901
Practice Address - Fax:865-475-8133
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS3944122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist