Provider Demographics
NPI:1962556589
Name:HARVEY, MARK ALLEN (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
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 1:1016 HEDY LYNN DR
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-1729
Mailing Address - Country:US
Mailing Address - Phone:412-751-1400
Mailing Address - Fax:412-751-0489
Practice Address - Street 1:1016 HEDY LYNN DR
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-1729
Practice Address - Country:US
Practice Address - Phone:412-751-1400
Practice Address - Fax:412-751-0489
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025798L1223G0001X
PADS02579L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA411973OtherUNITED CONCORDIA
PA0013903400002OtherMEDICAL ASSISTANCE
PA89821OtherUNISON