Provider Demographics
NPI:1740361559
Name:STEPHEN J HARKINS DDS PC
Entity type:Organization
Organization Name:STEPHEN J HARKINS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-298-6909
Mailing Address - Street 1:4781 E CAMP LOWELL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1290
Mailing Address - Country:US
Mailing Address - Phone:520-298-6909
Mailing Address - Fax:520-298-7376
Practice Address - Street 1:4781 E CAMP LOWELL DR STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1290
Practice Address - Country:US
Practice Address - Phone:520-298-6909
Practice Address - Fax:520-298-7376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD27751223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT76724Medicare UPIN
AZ76916Medicare PIN