Healthcare Provider Details

I. General information

NPI: 1013479880
Provider Name (Legal Business Name): HARVEY DENTAL CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 9TH ST W
HARVEY ND
58341-1505
US

IV. Provider business mailing address

118 9TH ST W
HARVEY ND
58341-1505
US

V. Phone/Fax

Practice location:
  • Phone: 701-324-4180
  • Fax: 701-324-4702
Mailing address:
  • Phone: 701-324-4180
  • Fax: 701-324-4702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREG CHRISTENSEN
Title or Position: DENTIST/OWNER
Credential:
Phone: 701-324-4180