Provider Demographics
NPI:1598254120
Name:HARWARD, NATHAN P (DMD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:P
Last Name:HARWARD
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 1:6144 BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-4148
Mailing Address - Country:US
Mailing Address - Phone:208-936-7111
Mailing Address - Fax:208-461-4013
Practice Address - Street 1:6144 BIRCH LN
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-4148
Practice Address - Country:US
Practice Address - Phone:208-936-7111
Practice Address - Fax:208-461-4013
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-49141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice