Provider Demographics
NPI:1972550697
Name:HENRY HARBERT DMD LLC
Entity Type:Organization
Organization Name:HENRY HARBERT DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:LUCIEN
Authorized Official - Last Name:HARBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-245-0984
Mailing Address - Street 1:691 MURPHY RD
Mailing Address - Street 2:#204
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:691 MURPHY RD
Practice Address - Street 2:#204
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4311
Practice Address - Country:US
Practice Address - Phone:541-245-0984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental