MEDICARE: DR. ALEXANDER JARAVA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019.031778	IL

General Provider Information

NPI Number	:	1023504578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER JARAVA DMD

Provider Business Mailing Address
First Line	:	2304 INDIAN RIDGE DR
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-1028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1768 W ALGONQUIN RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3405
Country	:	US
Telephone Number	:	331-234-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	07/09/2018

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