Healthcare Provider Details

I. General information

NPI: 1164462727
Provider Name (Legal Business Name): CHARLES KENNETT HARVEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3491 NW ANDERSON HILL RD
SILVERDALE WA
98383
US

IV. Provider business mailing address

PO BOX 3710
SILVERDALE WA
98383-3710
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDE00007743
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: