Provider Demographics
NPI:1649324781
Name:HARKEY, MAX E (DMD)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:E
Last Name:HARKEY
Suffix:
Gender:M
Credentials:DMD
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 585
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65704-0585
Mailing Address - Country:US
Mailing Address - Phone:417-924-3262
Mailing Address - Fax:
Practice Address - Street 1:104 S. LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MO
Practice Address - Zip Code:65704
Practice Address - Country:US
Practice Address - Phone:417-924-3262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0144131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice