Provider Demographics
NPI:1811252505
Name:HARA, PETER D (DMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:D
Last Name:HARA
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 1:77490 CALLE ARROBA
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-3510
Mailing Address - Country:US
Mailing Address - Phone:937-475-4275
Mailing Address - Fax:
Practice Address - Street 1:11750 CHOLLA DR STE B
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-3066
Practice Address - Country:US
Practice Address - Phone:760-251-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS100-9601223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health