Provider Demographics
NPI:1346970738
Name:HARVEY, CLARA LYNN (DMD)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:LYNN
Last Name:HARVEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7517 SMOKEY RD
Mailing Address - Street 2:
Mailing Address - City:GLEN SAINT MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32040-5318
Mailing Address - Country:US
Mailing Address - Phone:904-631-4535
Mailing Address - Fax:
Practice Address - Street 1:255 SW MAIN BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-7050
Practice Address - Country:US
Practice Address - Phone:386-752-2480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27052122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist