Provider Demographics
NPI:1063421501
Name:DOERR, HAROLD A (DDS)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:A
Last Name:DOERR
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 1:2800 JACKSON BLVD
Mailing Address - Street 2:SUITE #6
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-1504
Mailing Address - Country:US
Mailing Address - Phone:605-348-2556
Mailing Address - Fax:605-348-1526
Practice Address - Street 1:2800 JACKSON BLVD
Practice Address - Street 2:SUITE #6
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-1504
Practice Address - Country:US
Practice Address - Phone:605-348-2556
Practice Address - Fax:605-348-1526
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM6781223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics