Provider Demographics
NPI:1205270360
Name:HARPER, MITCHELL R (DDS)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:R
Last Name:HARPER
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 1:5422 EUPER LN
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3232
Mailing Address - Country:US
Mailing Address - Phone:479-452-1638
Mailing Address - Fax:479-452-1939
Practice Address - Street 1:5422 EUPER LN
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3232
Practice Address - Country:US
Practice Address - Phone:479-452-1638
Practice Address - Fax:479-452-1939
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist