Provider Demographics
NPI:1508622390
Name:HARBOR VIEW DENTISTRY
Entity Type:Organization
Organization Name:HARBOR VIEW DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PASONO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-639-1215
Mailing Address - Street 1:336 E HARBOR VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-1954
Mailing Address - Country:US
Mailing Address - Phone:920-922-9400
Mailing Address - Fax:
Practice Address - Street 1:336 E HARBOR VIEW DR
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-1954
Practice Address - Country:US
Practice Address - Phone:920-922-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental