Provider Demographics
NPI:1568954220
Name:HARDEN, LUKE A
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:A
Last Name:HARDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 NE 3RD ST STE B105
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3105
Mailing Address - Country:US
Mailing Address - Phone:541-617-9736
Mailing Address - Fax:
Practice Address - Street 1:1250 NE 3RD ST STE B105
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3105
Practice Address - Country:US
Practice Address - Phone:541-617-9736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4654122300000X, 1223E0200X
390200000X
ORD116601223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program