Provider Demographics
NPI:1649043001
Name:HARMON AND OTTESON DENTAL MANAGEMENT LLC
Entity type:Organization
Organization Name:HARMON AND OTTESON DENTAL MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-669-1254
Mailing Address - Street 1:1050 E FLAMINGO RD STE N147
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-7427
Mailing Address - Country:US
Mailing Address - Phone:765-669-1254
Mailing Address - Fax:
Practice Address - Street 1:5061 E SAHARA AVE STE 1A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89142-2986
Practice Address - Country:US
Practice Address - Phone:702-641-8868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty