MEDICARE: DR. ROBERT ELTON JARVIS II DDS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DF029956	CA

General Provider Information

NPI Number	:	1275659336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ELTON JARVIS II DDS

Provider Business Mailing Address
First Line	:	2211 4TH ST
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-3210
Country	:	US
Telephone Number	:	707-575-1198
Fax Number	:	707-575-0818

Provider Business Practice Location Address
First Line	:	2211 4TH ST
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-3210
Country	:	US
Telephone Number	:	707-575-1198
Fax Number	:	707-575-0818

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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