Provider Demographics
NPI:1669746962
Name:HARTER, THOMAS WILLIAM (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILLIAM
Last Name:HARTER
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 1:2609 SW 33RD ST STE 104
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7775
Mailing Address - Country:US
Mailing Address - Phone:352-873-1335
Mailing Address - Fax:352-873-4616
Practice Address - Street 1:2609 SW 33RD ST STE 104
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7775
Practice Address - Country:US
Practice Address - Phone:352-873-1335
Practice Address - Fax:352-873-4616
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN13595OtherDENTIST