Healthcare Provider Details

I. General information

NPI: 1518259845
Provider Name (Legal Business Name): BRIEN V HARVEY DDS. MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 N WILMOT RD E-2
TUCSON AZ
85711-1714
US

IV. Provider business mailing address

899 N WILMOT RD E-2
TUCSON AZ
85711-1714
US

V. Phone/Fax

Practice location:
  • Phone: 520-745-5722
  • Fax: 520-745-2991
Mailing address:
  • Phone: 520-745-5722
  • Fax: 520-745-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD3624
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: