Provider Demographics
NPI:1972713980
Name:HARMON, JEFFERY TODD (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:TODD
Last Name:HARMON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W 36TH ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-7820
Mailing Address - Country:US
Mailing Address - Phone:812-482-1060
Mailing Address - Fax:812-482-4515
Practice Address - Street 1:255 W 36TH ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-7820
Practice Address - Country:US
Practice Address - Phone:812-482-1060
Practice Address - Fax:812-482-4515
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009966122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist