Provider Demographics
NPI:1801212451
Name:HARVEY DENTAL CLINIC PC
Entity Type:Organization
Organization Name:HARVEY DENTAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOYMERAC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:906-401-0121
Mailing Address - Street 1:57 GRIMES RD
Mailing Address - Street 2:
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-9600
Mailing Address - Country:US
Mailing Address - Phone:906-401-0121
Mailing Address - Fax:
Practice Address - Street 1:2336 US 41 S
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-9122
Practice Address - Country:US
Practice Address - Phone:906-249-1040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty