Provider Demographics
NPI:1619383023
Name:HARMON, SHANE LEMYEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:LEMYEL
Last Name:HARMON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 E MICHIGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-3131
Mailing Address - Country:US
Mailing Address - Phone:219-874-7224
Mailing Address - Fax:219-879-8153
Practice Address - Street 1:4212 E MICHIGAN BLVD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-3131
Practice Address - Country:US
Practice Address - Phone:219-874-7224
Practice Address - Fax:219-879-8153
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012138A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice