Provider Demographics
NPI:1811104029
Name:KAISER, HARVEY WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:WAYNE
Last Name:KAISER
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 1:4360 E BLUEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-1442
Mailing Address - Country:US
Mailing Address - Phone:602-485-9123
Mailing Address - Fax:
Practice Address - Street 1:4360 E BLUEFIELD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-1442
Practice Address - Country:US
Practice Address - Phone:602-485-9123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD70381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice