Provider Demographics
NPI:1912129305
Name:HARVEY, SHAWN RICHARD
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:RICHARD
Last Name:HARVEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 RED LADY ST
Mailing Address - Street 2:#120
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-9656
Mailing Address - Country:US
Mailing Address - Phone:970-349-5731
Mailing Address - Fax:970-349-0562
Practice Address - Street 1:511 RED LADY ST
Practice Address - Street 2:
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224-9656
Practice Address - Country:US
Practice Address - Phone:970-349-5731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO80191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice