Provider Demographics
NPI:1417196387
Name:HARVEY, JEFFREY RUSSELL (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:RUSSELL
Last Name:HARVEY
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 1:241 N KANAWHA ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4716
Mailing Address - Country:US
Mailing Address - Phone:304-253-4900
Mailing Address - Fax:304-253-1319
Practice Address - Street 1:241 N KANAWHA ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4716
Practice Address - Country:US
Practice Address - Phone:304-253-4900
Practice Address - Fax:304-253-1319
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVBH5400053OtherDEA