Provider Demographics
NPI:1558557835
Name:HARNOIS, GARY (DDS)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:HARNOIS
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 1:650 INTERNATIONAL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-2986
Mailing Address - Country:US
Mailing Address - Phone:510-836-4755
Mailing Address - Fax:510-836-4715
Practice Address - Street 1:650 INTERNATIONAL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-2986
Practice Address - Country:US
Practice Address - Phone:510-836-4755
Practice Address - Fax:510-836-4715
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD21893122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist