Provider Demographics
NPI:1598988230
Name:HARALSON, DAVID JONATHAN (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JONATHAN
Last Name:HARALSON
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
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Mailing Address - Street 1:509 OLIVE WAY
Mailing Address - Street 2:SUITE1331
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1720
Mailing Address - Country:US
Mailing Address - Phone:206-624-0852
Mailing Address - Fax:206-622-2084
Practice Address - Street 1:509 OLIVE WAY
Practice Address - Street 2:SUITE1331
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1720
Practice Address - Country:US
Practice Address - Phone:206-624-0852
Practice Address - Fax:206-622-2084
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE63961223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery