Provider Demographics
NPI:1447420757
Name:HARMESON, PHILIP N (DDS)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:N
Last Name:HARMESON
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 1:431 MUNSON AVE
Mailing Address - Street 2:STE B
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686
Mailing Address - Country:US
Mailing Address - Phone:231-946-9045
Mailing Address - Fax:231-946-6318
Practice Address - Street 1:431 MUNSON AVE
Practice Address - Street 2:STE B
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686
Practice Address - Country:US
Practice Address - Phone:231-946-9045
Practice Address - Fax:231-946-6318
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI119021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice