Healthcare Provider Details

I. General information

NPI: 1366507337
Provider Name (Legal Business Name): MATTHEW D JERVIS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 29TH AVE SW
ALBANY OR
97321-3416
US

IV. Provider business mailing address

1030 29TH AVE SW
ALBANY OR
97321-3416
US

V. Phone/Fax

Practice location:
  • Phone: 541-924-1190
  • Fax:
Mailing address:
  • Phone: 541-924-1190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD8638
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: