Provider Demographics
NPI:1982258638
Name:HARBACH, LUKE WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:WILLIAM
Last Name:HARBACH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E YORBA LINDA BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-2910
Mailing Address - Country:US
Mailing Address - Phone:714-524-0207
Mailing Address - Fax:
Practice Address - Street 1:300 E YORBA LINDA BLVD STE E
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-2910
Practice Address - Country:US
Practice Address - Phone:714-524-0207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1040621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty