Provider Demographics
NPI:1013479880
Name:HARVEY DENTAL CLINIC PC
Entity Type:Organization
Organization Name:HARVEY DENTAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-324-4180
Mailing Address - Street 1:118 9TH ST W
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:ND
Mailing Address - Zip Code:58341-1505
Mailing Address - Country:US
Mailing Address - Phone:701-324-4180
Mailing Address - Fax:701-324-4702
Practice Address - Street 1:118 9TH ST W
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:ND
Practice Address - Zip Code:58341-1505
Practice Address - Country:US
Practice Address - Phone:701-324-4180
Practice Address - Fax:701-324-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND2372Medicaid
ND2372OtherNORTH DAKOTA LICENSE NUMBER