Provider Demographics
NPI:1437157377
Name:HARPER, GERALD ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:ALAN
Last Name:HARPER
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 1:2650 SUZANNE WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-7319
Mailing Address - Country:US
Mailing Address - Phone:541-726-4690
Mailing Address - Fax:541-741-7230
Practice Address - Street 1:2650 SUZANNE WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7319
Practice Address - Country:US
Practice Address - Phone:541-726-4690
Practice Address - Fax:541-741-7230
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD53821223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR018622Medicaid
OR0000NGBJPMedicare ID - Type UnspecifiedMEDICARE PROVIDER
OR018622Medicaid