Provider Demographics
NPI:1366677601
Name:HARLESS, VICKI (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:
Last Name:HARLESS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 S HOUSTON AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-8903
Mailing Address - Country:US
Mailing Address - Phone:918-581-2236
Mailing Address - Fax:
Practice Address - Street 1:440 S HOUSTON AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-8903
Practice Address - Country:US
Practice Address - Phone:918-581-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK49511223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health