Provider Demographics
NPI:1952788150
Name:DAVID J HARALSON
Entity Type:Organization
Organization Name:DAVID J HARALSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD, DMD
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HARALSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-624-0852
Mailing Address - Street 1:509 OLIVE WAY STE 1331
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1743
Mailing Address - Country:US
Mailing Address - Phone:206-624-0852
Mailing Address - Fax:
Practice Address - Street 1:509 OLIVE WAY STE 1331
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1743
Practice Address - Country:US
Practice Address - Phone:206-624-0852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602955711223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty