Healthcare Provider Details

I. General information

NPI: 1265737597
Provider Name (Legal Business Name): CHARLES K. HARVEY D.D.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3491 NW ANDERSON HILL RD
SILVERDALE WA
98383-7859
US

IV. Provider business mailing address

PO BOX 3710
SILVERDALE WA
98383-3710
US

V. Phone/Fax

Practice location:
  • Phone: 360-692-8600
  • Fax: 360-692-5364
Mailing address:
  • Phone: 360-692-8600
  • Fax: 360-692-5364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberWA00008594
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberWA00007743
License Number StateWA

VIII. Authorized Official

Name: DR. CHARLES K. HARVEY
Title or Position: OWNER
Credential: DDS
Phone: 360-692-8600