Provider Demographics
NPI:1679132807
Name:HARVEY, KIRK WADE (DMD)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:WADE
Last Name:HARVEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 BRAEBURN CT
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-4177
Mailing Address - Country:US
Mailing Address - Phone:720-255-7900
Mailing Address - Fax:
Practice Address - Street 1:214 5TH ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5109
Practice Address - Country:US
Practice Address - Phone:970-686-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002040361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice