Provider Demographics
NPI:1326508060
Name:HARPER FAMILY DENTISTY, PLLC
Entity Type:Organization
Organization Name:HARPER FAMILY DENTISTY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-217-8926
Mailing Address - Street 1:908 PALM BLVD S
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2603
Mailing Address - Country:US
Mailing Address - Phone:850-729-1223
Mailing Address - Fax:
Practice Address - Street 1:908 PALM BLVD S
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2603
Practice Address - Country:US
Practice Address - Phone:850-729-1223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental