Provider Demographics
NPI:1780932277
Name:HARVEY DENTISTRY NRKE
Entity type:Organization
Organization Name:HARVEY DENTISTRY NRKE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:540-904-0300
Mailing Address - Street 1:5049 VALLEY VIEW BLVD NW STE C
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-2075
Mailing Address - Country:US
Mailing Address - Phone:540-904-0300
Mailing Address - Fax:
Practice Address - Street 1:5049 VALLEY VIEW BLVD NW STE C
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-2075
Practice Address - Country:US
Practice Address - Phone:540-904-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410880261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental