Provider Demographics
NPI:1477574069
Name:HARWOOD, MARK ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:HARWOOD
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 1:122 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-2520
Mailing Address - Country:US
Mailing Address - Phone:918-486-3266
Mailing Address - Fax:
Practice Address - Street 1:122 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429-2520
Practice Address - Country:US
Practice Address - Phone:918-486-3266
Practice Address - Fax:918-486-3296
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60145122300000X
OK5757122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist