Provider Demographics
NPI:1952320780
Name:HARMETZ, RICHARD ALLEN (DSS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
Last Name:HARMETZ
Suffix:
Gender:M
Credentials:DSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8899 UNIVERSITY CENTER LN
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1013
Mailing Address - Country:US
Mailing Address - Phone:858-452-3636
Mailing Address - Fax:858-452-5558
Practice Address - Street 1:8899 UNIVERSITY CENTER LN
Practice Address - Street 2:SUITE 180
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1013
Practice Address - Country:US
Practice Address - Phone:858-452-3636
Practice Address - Fax:858-452-5558
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA222281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice