Provider Demographics
NPI:1346925351
Name:HARL, NICHOLAS JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JAY
Last Name:HARL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:NICK
Other - Middle Name:JAY
Other - Last Name:HARL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2601 RANGE LINE ST STE 111
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-1618
Mailing Address - Country:US
Mailing Address - Phone:573-355-5870
Mailing Address - Fax:
Practice Address - Street 1:2601 RANGE LINE ST STE 111
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-1618
Practice Address - Country:US
Practice Address - Phone:573-355-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023022868122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist