Provider Demographics
NPI:1497718183
Name:HARVEY, DALE WARREN (DDS)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:WARREN
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 1:9035 N 43RD AVE
Mailing Address - Street 2:#B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051
Mailing Address - Country:US
Mailing Address - Phone:623-931-2419
Mailing Address - Fax:623-939-7913
Practice Address - Street 1:9035 N 43RD AVE
Practice Address - Street 2:#B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051
Practice Address - Country:US
Practice Address - Phone:623-931-2419
Practice Address - Fax:623-939-7913
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice