Provider Demographics
NPI:1396963419
Name:HARGARVES, WILLIAM HENRY (DDS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENRY
Last Name:HARGARVES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-1756
Mailing Address - Country:US
Mailing Address - Phone:850-265-8983
Mailing Address - Fax:850-265-8816
Practice Address - Street 1:620 OHIO AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-1756
Practice Address - Country:US
Practice Address - Phone:850-265-8983
Practice Address - Fax:850-265-8816
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10068122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist