Provider Demographics
NPI:1164980140
Name:KALEB E HARP DDS PLLC
Entity Type:Organization
Organization Name:KALEB E HARP DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KALEB
Authorized Official - Middle Name:
Authorized Official - Last Name:HARP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-926-9278
Mailing Address - Street 1:900 SOUTHWEST DR STE D
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7077
Mailing Address - Country:US
Mailing Address - Phone:870-520-6016
Mailing Address - Fax:
Practice Address - Street 1:900 SOUTHWEST DR STE D
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7077
Practice Address - Country:US
Practice Address - Phone:870-520-6016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental