Provider Demographics
NPI: | 1710107008 |
---|---|
Name: | HAROLD A. DOERR, D.D.S, PC |
Entity Type: | Organization |
Organization Name: | HAROLD A. DOERR, D.D.S, PC |
Other - Org Name: | DAKOTA REGIONAL PERIODONTICS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DENTIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | HAROLD |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | DOERR |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 605-348-2556 |
Mailing Address - Street 1: | 2800 JACKSON BLVD |
Mailing Address - Street 2: | SUITE #6 |
Mailing Address - City: | RAPID CITY |
Mailing Address - State: | SD |
Mailing Address - Zip Code: | 57702-3477 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 605-348-2556 |
Mailing Address - Fax: | 605-348-1526 |
Practice Address - Street 1: | 2800 JACKSON BLVD |
Practice Address - Street 2: | SUITE #6 |
Practice Address - City: | RAPID CITY |
Practice Address - State: | SD |
Practice Address - Zip Code: | 57702-3477 |
Practice Address - Country: | US |
Practice Address - Phone: | 605-348-2556 |
Practice Address - Fax: | 605-348-1526 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-04-27 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223P0300X | Dental Providers | Dentist | Periodontics | Group - Single Specialty |