Provider Demographics
NPI:1679190953
Name:HARMON DENTURE CLINIC LLC
Entity Type:Organization
Organization Name:HARMON DENTURE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUS MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:BUS MGR
Authorized Official - Phone:405-332-4160
Mailing Address - Street 1:104 E MCELROY RD STE 4
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-3803
Mailing Address - Country:US
Mailing Address - Phone:405-332-4160
Mailing Address - Fax:405-332-4164
Practice Address - Street 1:104 E MCELROY RD STE 4
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-3803
Practice Address - Country:US
Practice Address - Phone:405-332-4160
Practice Address - Fax:405-332-4164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4053324160Medicaid