Provider Demographics
NPI:1497880694
Name:HARNICK, DAVID J (DDS,MSD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:HARNICK
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8631 F GOLF COURSE, NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114
Mailing Address - Country:US
Mailing Address - Phone:505-831-1600
Mailing Address - Fax:505-899-0408
Practice Address - Street 1:8631 F GOLF COURSE, NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114
Practice Address - Country:US
Practice Address - Phone:505-831-1600
Practice Address - Fax:505-899-0408
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics