Provider Demographics
NPI:1790893907
Name:HARMER, DOUGLAS PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:PAUL
Last Name:HARMER
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 1:340 FALCON RIDGE PKWY
Mailing Address - Street 2:BUILDING 300 SUITE C
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-8850
Mailing Address - Country:US
Mailing Address - Phone:702-346-5202
Mailing Address - Fax:
Practice Address - Street 1:340 FALCON RIDGE PKWY
Practice Address - Street 2:BUILDING 300 SUITE C
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-8850
Practice Address - Country:US
Practice Address - Phone:702-346-5202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV49701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ707854OtherAHCCCS