Provider Demographics
NPI:1538332457
Name:DR. DOUGLAS R. HARTY DDS
Entity Type:Organization
Organization Name:DR. DOUGLAS R. HARTY DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-881-1680
Mailing Address - Street 1:2801 FAIRVIEW PL
Mailing Address - Street 2:SUITE U
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1310
Mailing Address - Country:US
Mailing Address - Phone:317-881-1680
Mailing Address - Fax:
Practice Address - Street 1:2801 FAIRVIEW PL
Practice Address - Street 2:SUITE U
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1310
Practice Address - Country:US
Practice Address - Phone:317-881-1680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN85011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty