Provider Demographics
NPI:1023107828
Name:HARMON, JOHN BRADLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRADLEY
Last Name:HARMON
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 1:3631 MAPLEWOOD AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2149
Mailing Address - Country:US
Mailing Address - Phone:940-692-1530
Mailing Address - Fax:940-723-8550
Practice Address - Street 1:3631 MAPLEWOOD AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2149
Practice Address - Country:US
Practice Address - Phone:940-692-1530
Practice Address - Fax:940-723-8550
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX136261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice