Provider Demographics
NPI:1073616074
Name:DAVID J HARRELL DDS INC
Entity Type:Organization
Organization Name:DAVID J HARRELL DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-248-7333
Mailing Address - Street 1:4417 WEST GORE BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505
Mailing Address - Country:US
Mailing Address - Phone:580-248-7333
Mailing Address - Fax:580-248-7365
Practice Address - Street 1:4417 WEST GORE BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505
Practice Address - Country:US
Practice Address - Phone:580-248-7333
Practice Address - Fax:580-248-7365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK41111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty