Provider Demographics
NPI:1326080227
Name:HARKER, JOHN DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:HARKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9909 N STATE ROAD 9
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:IN
Mailing Address - Zip Code:47246-8700
Mailing Address - Country:US
Mailing Address - Phone:812-546-4057
Mailing Address - Fax:812-546-5653
Practice Address - Street 1:9909 N STATE ROAD 9
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:IN
Practice Address - Zip Code:47246-8700
Practice Address - Country:US
Practice Address - Phone:812-546-4057
Practice Address - Fax:812-546-5653
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006884A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100051430Medicaid