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General NPI Number Information
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NPI Number | 1710003231
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Entity Type | Individual
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Provider Name | ELLEN RUDOLPH JARVIS DMD
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 02/25/2022
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Provider Practice Location Address
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Address Line | 3200 SYCAMORE CT. SUITE 1-C
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City | COLUMBUS
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State | IN
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Zip | 47203
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Country | US
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Telephone | 812-379-9211
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 SYCAMORE CT. SUITE 1-C
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City | COLUMBUS
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State | IN
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Zip | 47203
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Country | US
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Telephone | 812-379-9211
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12010901A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12010901A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D-0006947-C
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License Number State | AL
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