Provider Demographics
NPI:1750751822
Name:CU, HARVEY (LD)
Entity type:Individual
Prefix:
First Name:HARVEY
Middle Name:
Last Name:CU
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 SHERIDAN RD. SUITE B
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310
Mailing Address - Country:US
Mailing Address - Phone:360-627-7948
Mailing Address - Fax:360-627-8277
Practice Address - Street 1:2135 SHERIDAN RD STE B
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4680
Practice Address - Country:US
Practice Address - Phone:360-627-7948
Practice Address - Fax:360-627-8277
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN 60464161122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist