Provider Demographics
NPI:1790898153
Name:M DAWN HARVEY DMD PC
Entity Type:Organization
Organization Name:M DAWN HARVEY DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:HARVEY-GRUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-459-5778
Mailing Address - Street 1:105 DALLAS RD
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180
Mailing Address - Country:US
Mailing Address - Phone:770-459-5778
Mailing Address - Fax:770-459-6633
Practice Address - Street 1:105 DALLAS RD
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180
Practice Address - Country:US
Practice Address - Phone:770-459-5778
Practice Address - Fax:770-459-6633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012657122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty