Provider Demographics
NPI:1659822062
Name:GEORGE W. HARPER D.D.S., PC
Entity Type:Organization
Organization Name:GEORGE W. HARPER D.D.S., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-896-3600
Mailing Address - Street 1:918 PINEHURST RD. SE
Mailing Address - Street 2:STE-103
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124
Mailing Address - Country:US
Mailing Address - Phone:505-896-3600
Mailing Address - Fax:505-896-3690
Practice Address - Street 1:918 PINEHURST RD SE
Practice Address - Street 2:STE-103
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-2568
Practice Address - Country:US
Practice Address - Phone:505-896-3600
Practice Address - Fax:505-896-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD3164122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10572856Medicaid