Healthcare Provider Details

I. General information

NPI: 1669435806
Provider Name (Legal Business Name): BRYAN R. HARVEY DDS,MS,PC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 WARNER MILNE RD
OREGON CITY OR
97045-4045
US

IV. Provider business mailing address

331 WARNER MILNE RD
OREGON CITY OR
97045-4045
US

V. Phone/Fax

Practice location:
  • Phone: 503-655-6239
  • Fax: 503-655-0338
Mailing address:
  • Phone: 503-655-6239
  • Fax: 503-655-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberD8283
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: