Provider Demographics
NPI:1306117486
Name:HARVEST FAMILY DENTISTRY
Entity type:Organization
Organization Name:HARVEST FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-466-9608
Mailing Address - Street 1:5850 HIGHWAY 53
Mailing Address - Street 2:SUITE Y
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-4301
Mailing Address - Country:US
Mailing Address - Phone:256-852-1100
Mailing Address - Fax:
Practice Address - Street 1:5850 HIGHWAY 53
Practice Address - Street 2:SUITE Y
Practice Address - City:HARVEST
Practice Address - State:AL
Practice Address - Zip Code:35749-4301
Practice Address - Country:US
Practice Address - Phone:256-852-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL57111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty