Provider Demographics
NPI:1306398318
Name:JOHN T HARVEY DDS
Entity Type:Organization
Organization Name:JOHN T HARVEY DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SELF EMPLOYED
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TIIMOTHY
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-721-3069
Mailing Address - Street 1:PO BOX 1845
Mailing Address - Street 2:
Mailing Address - City:ST FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775
Mailing Address - Country:US
Mailing Address - Phone:225-721-3069
Mailing Address - Fax:
Practice Address - Street 1:4638 PECAN GROVE ROAD
Practice Address - Street 2:
Practice Address - City:ST FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775
Practice Address - Country:US
Practice Address - Phone:225-721-3069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA38311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty