Provider Demographics
NPI:1578662268
Name:HARALAM, ALEX JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:JOHN
Last Name:HARALAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 EISENHOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4308
Mailing Address - Country:US
Mailing Address - Phone:717-394-3945
Mailing Address - Fax:717-394-7562
Practice Address - Street 1:12 EISENHOWER BLVD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4308
Practice Address - Country:US
Practice Address - Phone:717-394-3945
Practice Address - Fax:717-394-7562
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017503-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice