Provider Demographics
NPI:1811001787
Name:DAVID L HARNETT
Entity Type:Organization
Organization Name:DAVID L HARNETT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-638-3065
Mailing Address - Street 1:500 WAKEFIELD DR STE 4
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1504
Mailing Address - Country:US
Mailing Address - Phone:330-638-3065
Mailing Address - Fax:330-638-4709
Practice Address - Street 1:500 WAKEFIELD DR STE 4
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-1504
Practice Address - Country:US
Practice Address - Phone:330-638-3065
Practice Address - Fax:330-638-4709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2383826Medicaid
OH0246620Medicaid