Healthcare Provider Details

I. General information

NPI: 1295848190
Provider Name (Legal Business Name): REED K JARVIS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: REED JARVIS I DDS

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 W PARK PL STE B
COEUR D ALENE ID
83814-2785
US

IV. Provider business mailing address

PO BOX 1387
HAYDEN ID
83835-1387
US

V. Phone/Fax

Practice location:
  • Phone: 208-292-0697
  • Fax: 208-292-0357
Mailing address:
  • Phone: 208-415-0299
  • Fax: 208-625-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8184825-9926
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD-1526
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: