Provider Demographics
NPI:1023228533
Name:HARVEY, GREGORY PETER (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PETER
Last Name:HARVEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:GREGORY
Other - Middle Name:PETER
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:607 HONEY BEAR CT
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-1071
Mailing Address - Country:US
Mailing Address - Phone:715-258-9348
Mailing Address - Fax:
Practice Address - Street 1:211 E. BADGER ST.
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981
Practice Address - Country:US
Practice Address - Phone:715-258-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2322122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist