Provider Demographics
NPI:1851438808
Name:HARDER, E. PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:E.
Middle Name:PAUL
Last Name:HARDER
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 1:2100 PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-2021
Mailing Address - Country:US
Mailing Address - Phone:573-221-1227
Mailing Address - Fax:573-221-5564
Practice Address - Street 1:2727 SAINT MARYS AVE
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-3774
Practice Address - Country:US
Practice Address - Phone:573-221-1227
Practice Address - Fax:573-221-5564
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0152971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO403004609Medicaid