Healthcare Provider Details

I. General information

NPI: 1780830240
Provider Name (Legal Business Name): AARON A. JARVIS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4717 E RAY RD
PHOENIX AZ
85044-6230
US

IV. Provider business mailing address

1161 E MAIN ST
MESA AZ
85203-8823
US

V. Phone/Fax

Practice location:
  • Phone: 480-755-4455
  • Fax: 480-893-7535
Mailing address:
  • Phone: 480-962-6983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD07606
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: