Provider Demographics
NPI:1831418318
Name:JARVIS, RAYMOND ARTHUR (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ARTHUR
Last Name:JARVIS
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 1:7607 FERN AVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5739
Mailing Address - Country:US
Mailing Address - Phone:318-797-1181
Mailing Address - Fax:318-797-1180
Practice Address - Street 1:7607 FERN AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5739
Practice Address - Country:US
Practice Address - Phone:318-797-1181
Practice Address - Fax:318-797-1180
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA60421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1860425Medicaid