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General NPI Number Information
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NPI Number | 1801212451
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Entity Type | Organization
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Legal Business Name | HARVEY DENTAL CLINIC PC
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Dates
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Enumeration Date | 03/06/2014
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Last Update Date | 03/06/2014
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Provider Practice Location Address
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Address Line | 2336 US 41 S
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City | MARQUETTE
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State | MI
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Zip | 49855-9122
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Country | US
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Telephone | 906-249-1040
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Fax |
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Provider Business Mailing Address
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Address Line | 57 GRIMES RD
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City | NEGAUNEE
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State | MI
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Zip | 49866-9600
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Country | US
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Telephone | 906-401-0121
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRETT S GOYMERAC
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Credential | DDS
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Telephone | 906-401-0121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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