Healthcare Provider Details

I. General information

NPI: 1649428566
Provider Name (Legal Business Name): JARROD ROBERT MCALEVY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 SOUTH 7TH STREET BLDG 700/700-A ROBINS AFB, GA
APO AA
31098
US

IV. Provider business mailing address

121 BAYSIDE CIRCLE
WARNER ROBINS GA
31088-5986
US

V. Phone/Fax

Practice location:
  • Phone: 14783278487
  • Fax:
Mailing address:
  • Phone: 308-440-0274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6772
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: