Healthcare Provider Details

I. General information

NPI: 1487605747
Provider Name (Legal Business Name): KEVIN JOSEPH GARVIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 EAST 2ND STREET
CLOVERDALE CA
95425
US

IV. Provider business mailing address

118 EAST 2ND STREET
CLOVERDALE CA
95425
US

V. Phone/Fax

Practice location:
  • Phone: 707-894-2514
  • Fax: 707-894-8404
Mailing address:
  • Phone: 707-894-2514
  • Fax: 707-894-8404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number39527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: