Provider Demographics
NPI:1235382326
Name:HARLAND, MISTI K
Entity Type:Individual
Prefix:
First Name:MISTI
Middle Name:K
Last Name:HARLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 HUGHES RD
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-7134
Mailing Address - Country:US
Mailing Address - Phone:432-517-0491
Mailing Address - Fax:
Practice Address - Street 1:508 HUGHES RD
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-7134
Practice Address - Country:US
Practice Address - Phone:432-517-0491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0014606124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist