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General NPI Number Information
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NPI Number | 1003954629
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Entity Type | Organization
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Legal Business Name | MARK H. HARVEY, D.M.D., PSC
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Dates
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Enumeration Date | 02/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1602 LAKEWOOD DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-5458
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Country | US
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Telephone | 270-737-3368
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Fax |
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Provider Business Mailing Address
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Address Line | 1602 LAKEWOOD DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-5458
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Country | US
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Telephone | 270-737-3368
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK H HARVEY
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Credential | DMD
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Telephone | 270-737-3368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5354
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License Number State | KY
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