Provider Demographics
NPI:1861416257
Name:JARVIS, PARKER M (DDS)
Entity type:Individual
Prefix:
First Name:PARKER
Middle Name:M
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 1:555 W SCHROCK RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8702
Mailing Address - Country:US
Mailing Address - Phone:614-882-5208
Mailing Address - Fax:614-882-6497
Practice Address - Street 1:555 W SCHROCK RD
Practice Address - Street 2:SUITE 120
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8702
Practice Address - Country:US
Practice Address - Phone:614-882-5208
Practice Address - Fax:614-882-6497
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice