Healthcare Provider Details

I. General information

NPI: 1871653246
Provider Name (Legal Business Name): DANIEL A HARVEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 DEPOT ST
JOHNSON CREEK WI
53038
US

IV. Provider business mailing address

PO BOX 326 113 DEPOT ST
JOHNSON CREEK WI
53038
US

V. Phone/Fax

Practice location:
  • Phone: 920-699-3344
  • Fax: 920-699-3340
Mailing address:
  • Phone: 920-699-3344
  • Fax: 920-699-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12692
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: