Provider Demographics
NPI:1053490565
Name:HARSHBERGER, DOUGLAS EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:EUGENE
Last Name:HARSHBERGER
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 1:19301 E. US 40 HIGHWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055
Mailing Address - Country:US
Mailing Address - Phone:816-886-5899
Mailing Address - Fax:816-886-5934
Practice Address - Street 1:19301 E US HIGHWAY 40
Practice Address - Street 2:SUITE A
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5446
Practice Address - Country:US
Practice Address - Phone:816-886-5899
Practice Address - Fax:816-886-5934
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0148641223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice