Provider Demographics
NPI:1205032778
Name:HARBAUGH, PHAEDRA G (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHAEDRA
Middle Name:G
Last Name:HARBAUGH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 CROYDON RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-1433
Mailing Address - Country:US
Mailing Address - Phone:585-482-6041
Mailing Address - Fax:585-385-9072
Practice Address - Street 1:213 W COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:E ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445-2153
Practice Address - Country:US
Practice Address - Phone:585-586-4674
Practice Address - Fax:585-385-9072
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051988-011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice