Provider Demographics
NPI:1720323421
Name:HARBOR COVE DENTAL
Entity Type:Organization
Organization Name:HARBOR COVE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEIF
Authorized Official - Middle Name:K
Authorized Official - Last Name:BAKLAND
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:978-265-7022
Mailing Address - Street 1:123 MAIN ST
Mailing Address - Street 2:2ND FLR
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-5766
Mailing Address - Country:US
Mailing Address - Phone:978-865-3360
Mailing Address - Fax:
Practice Address - Street 1:123 MAIN ST
Practice Address - Street 2:2ND FLR
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-5766
Practice Address - Country:US
Practice Address - Phone:978-865-3360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty