Provider Demographics
NPI:1093884074
Name:HARLEY ODDEN DDS, INC
Entity Type:Organization
Organization Name:HARLEY ODDEN DDS, INC
Other - Org Name:HILLVIEW DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARLEY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ODDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-651-1440
Mailing Address - Street 1:40739 GRIMMER BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2800
Mailing Address - Country:US
Mailing Address - Phone:510-651-1440
Mailing Address - Fax:510-651-1454
Practice Address - Street 1:40739 GRIMMER BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2800
Practice Address - Country:US
Practice Address - Phone:510-651-1440
Practice Address - Fax:510-651-1454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP 25861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty