Provider Demographics
NPI:1760596761
Name:JAY A. HARLAN, D.D.S., INC.
Entity Type:Organization
Organization Name:JAY A. HARLAN, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HARLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-632-9726
Mailing Address - Street 1:8101 S WALKER AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9418
Mailing Address - Country:US
Mailing Address - Phone:405-632-9726
Mailing Address - Fax:405-632-9728
Practice Address - Street 1:8101 S WALKER AVE
Practice Address - Street 2:SUITE E
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9418
Practice Address - Country:US
Practice Address - Phone:405-632-9726
Practice Address - Fax:405-632-9728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK50921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100743750AMedicaid
OKOKB0010Medicare PIN