Provider Demographics
NPI:1235390543
Name:HARPER, DUSTIN RAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:RAY
Last Name:HARPER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 PRIDE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-9107
Mailing Address - Country:US
Mailing Address - Phone:270-821-3423
Mailing Address - Fax:
Practice Address - Street 1:1410 PRIDE AVE STE C
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-9107
Practice Address - Country:US
Practice Address - Phone:270-821-3423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY86421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice