Provider Demographics
NPI:1619143872
Name:AARON S HARMAN DDS PC INC DBA LAKESIDE DENTAL
Entity Type:Organization
Organization Name:AARON S HARMAN DDS PC INC DBA LAKESIDE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:SHAY
Authorized Official - Last Name:HARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-485-3371
Mailing Address - Street 1:302 S HAYES
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467
Mailing Address - Country:US
Mailing Address - Phone:918-485-3371
Mailing Address - Fax:918-485-9175
Practice Address - Street 1:302 S HAYES
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467
Practice Address - Country:US
Practice Address - Phone:918-485-3371
Practice Address - Fax:918-485-9175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK56051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200001150AMedicaid