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Individual

DR. ELLEN RUDOLPH JARVIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DMD

Contact information

Practice address
3200 SYCAMORE CT. SUITE 1-C, COLUMBUS, IN 47203
(812) 379-9211
Mailing address
3200 SYCAMORE CT. SUITE 1-C, COLUMBUS, IN 47203
(812) 379-9211

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
12010901A
IN
1223G0001X
General Practice Dentistry
12010901A
IN
1223G0001X
General Practice Dentistry
Primary
D-0006947-C
AL

Other

Enumeration date
03/22/2007
Last updated
02/25/2022
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