Provider Demographics
NPI:1497247860
Name:HARRAMAN, PRESTON EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:EUGENE
Last Name:HARRAMAN
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 1:1832 CHELSEA DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-4300
Mailing Address - Country:US
Mailing Address - Phone:405-640-2166
Mailing Address - Fax:
Practice Address - Street 1:775 W COVELL RD STE 160
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-2302
Practice Address - Country:US
Practice Address - Phone:405-844-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK70451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice