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General NPI Number Information
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NPI Number | 1194191452
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Entity Type | Organization
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Legal Business Name | PAUL D HARVEY DDS
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Dates
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Enumeration Date | 08/20/2015
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Last Update Date | 08/20/2015
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Provider Practice Location Address
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Address Line | 569A COURT ST
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City | APPOMATTOX
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State | VA
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Zip | 24522-8212
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Country | US
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Telephone | 434-352-9525
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Fax | 434-352-0834
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Provider Business Mailing Address
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Address Line | PO BOX 280 569 A COURT STREET
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City | APPOMATTOX
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State | VA
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Zip | 24522-0280
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Country | US
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Telephone | 434-352-9525
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Fax | 434-352-0834
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TAMMY L DAVIS
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Credential |
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Telephone | 434-352-9525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 05638
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License Number State | VA
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