Provider Demographics
NPI:1841417003
Name:TOWN DENTAL, PA
Entity Type:Organization
Organization Name:TOWN DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARVIEUX
Authorized Official - Suffix:
Authorized Official - Credentials:DENTIST
Authorized Official - Phone:952-488-3077
Mailing Address - Street 1:700 WESTON RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1202
Mailing Address - Country:US
Mailing Address - Phone:952-368-3356
Mailing Address - Fax:
Practice Address - Street 1:407 CITY HALL PLZ
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1970
Practice Address - Country:US
Practice Address - Phone:952-448-3077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11057122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty