Provider Demographics
NPI:1871653246
Name:HARVEY, DANIEL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
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:PO BOX 326
Mailing Address - Street 2:113 DEPOT ST
Mailing Address - City:JOHNSON CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53038
Mailing Address - Country:US
Mailing Address - Phone:920-699-3344
Mailing Address - Fax:920-699-3340
Practice Address - Street 1:113 DEPOT ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CREEK
Practice Address - State:WI
Practice Address - Zip Code:53038
Practice Address - Country:US
Practice Address - Phone:920-699-3344
Practice Address - Fax:920-699-3340
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12692122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
79926Medicare ID - Type Unspecified
WI33429500Medicare ID - Type Unspecified