Provider Demographics
NPI:1598830390
Name:HARMAN, MICHELLE L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:L
Last Name:HARMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:420 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:ODON
Mailing Address - State:IN
Mailing Address - Zip Code:47562-1036
Mailing Address - Country:US
Mailing Address - Phone:812-636-4334
Mailing Address - Fax:812-636-8325
Practice Address - Street 1:420 N WEST ST
Practice Address - Street 2:
Practice Address - City:ODON
Practice Address - State:IN
Practice Address - Zip Code:47562-1036
Practice Address - Country:US
Practice Address - Phone:812-636-4334
Practice Address - Fax:812-636-8325
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010880A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200844290Medicaid