Active NPI
Raymond Arthur Jarvis, D.D.S.
- General Practice Dentistry
- Shreveport, LA
National Provider Identifier
1831418318
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6042
- Practice address
- 7607 Fern Ave
Suite 800
Shreveport, LA 71105-5739 - Phone
- (318) 797-1181
- Fax
- (318) 797-1180
- NPI assigned
- May 24, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6042 | LA | Primary |
Addresses
Primary practice location
7607 Fern Ave
Suite 800
Shreveport, LA 71105-5739
Mailing address
7607 Fern Ave
Suite 800
Shreveport, LA 71105-5739
Phone (318) 797-1181
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1860425 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6042 | LA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Restoration Dental Group LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dental Clinic/Center
- Shreveport, LA
- NPI 1093035081
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325635200000",
"number": "1831418318",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7607 FERN AVE",
"address_2": "SUITE 800",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711055739",
"telephone_number": "318-797-1181",
"fax_number": "318-797-1180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7607 FERN AVE",
"address_2": "SUITE 800",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711055739",
"telephone_number": "318-797-1181",
"fax_number": "318-797-1180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JARVIS",
"first_name": "RAYMOND",
"middle_name": "ARTHUR",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-05-24",
"last_updated": "2012-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "LA",
"license": "6042",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1860425",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.