Provider Demographics
NPI:1225189244
Name:HARVEL, JR, DOUGLAS F (DMD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:F
Last Name:HARVEL, JR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 HIGHWAY 35 SOUTH
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074
Mailing Address - Country:US
Mailing Address - Phone:601-469-3851
Mailing Address - Fax:601-469-4356
Practice Address - Street 1:1040 HIGHWAY 35 S
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074
Practice Address - Country:US
Practice Address - Phone:601-469-3851
Practice Address - Fax:601-469-4356
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS30401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660246Medicaid