Provider Demographics
NPI:1457485971
Name:HARMONY DENTAL OF SOUTHPORT
Entity Type:Organization
Organization Name:HARMONY DENTAL OF SOUTHPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-457-7167
Mailing Address - Street 1:904 ALDEN BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8321
Mailing Address - Country:US
Mailing Address - Phone:919-468-9417
Mailing Address - Fax:
Practice Address - Street 1:4742 LONG BEACH RD SE
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-8721
Practice Address - Country:US
Practice Address - Phone:910-457-7167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty