Provider Demographics
NPI:1568956316
Name:HARVEY DENTISTRY CBRG PC
Entity Type:Organization
Organization Name:HARVEY DENTISTRY CBRG PC
Other - Org Name:BLUE RIDGE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HUMAN RESOURCES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:GUERRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-444-5659
Mailing Address - Street 1:1618 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-3116
Mailing Address - Country:US
Mailing Address - Phone:540-444-5649
Mailing Address - Fax:
Practice Address - Street 1:1580 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-1478
Practice Address - Country:US
Practice Address - Phone:540-444-5659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental