Healthcare Provider Details

I. General information

NPI: 1801212451
Provider Name (Legal Business Name): HARVEY DENTAL CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2336 US 41 S
MARQUETTE MI
49855-9122
US

IV. Provider business mailing address

57 GRIMES RD
NEGAUNEE MI
49866-9600
US

V. Phone/Fax

Practice location:
  • Phone: 906-249-1040
  • Fax:
Mailing address:
  • Phone: 906-401-0121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. BRETT S GOYMERAC
Title or Position: OWNER
Credential: DDS
Phone: 906-401-0121