Provider Demographics
NPI:1164484929
Name:MCKELVEY, HAROLD C (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:C
Last Name:MCKELVEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22629 TWAIN HARTE DR
Mailing Address - Street 2:
Mailing Address - City:TWAIN HARTE
Mailing Address - State:CA
Mailing Address - Zip Code:95383-9628
Mailing Address - Country:US
Mailing Address - Phone:209-586-2772
Mailing Address - Fax:209-686-4612
Practice Address - Street 1:22629 TWAIN HARTE DR
Practice Address - Street 2:
Practice Address - City:TWAIN HARTE
Practice Address - State:CA
Practice Address - Zip Code:95383-9628
Practice Address - Country:US
Practice Address - Phone:209-586-2772
Practice Address - Fax:209-686-4612
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34879122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist