Provider Demographics
NPI:1336355700
Name:HARELSON, JUNE MARIE (BSDH, RDHAP)
Entity Type:Individual
Prefix:MS
First Name:JUNE
Middle Name:MARIE
Last Name:HARELSON
Suffix:
Gender:F
Credentials:BSDH, RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6624 LAS ANIMAS DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-6109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6624 LAS ANIMAS DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-6109
Practice Address - Country:US
Practice Address - Phone:925-930-8087
Practice Address - Fax:925-937-8781
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58124Q00000X
CA17868124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist