Healthcare Provider Details

I. General information

NPI: 1124299110
Provider Name (Legal Business Name): HARVEY DENTISTRY NRV, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4664 LEE HWY
DUBLIN VA
24084
US

IV. Provider business mailing address

101 S COLORADO ST
SALEM VA
24153-3848
US

V. Phone/Fax

Practice location:
  • Phone: 540-674-8891
  • Fax: 540-671-9210
Mailing address:
  • Phone: 540-389-0720
  • Fax: 540-389-7702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number0401410880
License Number StateVA

VIII. Authorized Official

Name: DR. GREGORY T. HARVEY
Title or Position: PRESIDENT
Credential: DMD
Phone: 540-389-0720