MEDICARE: DR. WILLIAM DAVID JARVIS DDS MS PA

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	1223E0200X	Endodontics	5447	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5447	OTHER	NC	LICENSE NUMBER

General Provider Information

NPI Number	:	1497972830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM DAVID JARVIS DDS MS PA

Provider Business Mailing Address
First Line	:	105 ZEBULON COURT
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-2420
Country	:	US
Telephone Number	:	252-443-3200
Fax Number	:	252-443-6669

Provider Business Practice Location Address
First Line	:	105 ZEBULON COURT
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-2420
Country	:	US
Telephone Number	:	252-443-3200
Fax Number	:	252-443-6669

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	07/08/2007

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