Provider Demographics
NPI:1124168901
Name:HARBOUR DENTAL INC
Entity type:Organization
Organization Name:HARBOUR DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KRONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-739-6818
Mailing Address - Street 1:13628 HULL STREET RD
Mailing Address - Street 2:SUITE14
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2108
Mailing Address - Country:US
Mailing Address - Phone:804-739-6818
Mailing Address - Fax:804-639-1610
Practice Address - Street 1:13628 HULL STREET RD
Practice Address - Street 2:SUITE14
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2108
Practice Address - Country:US
Practice Address - Phone:804-739-6818
Practice Address - Fax:804-639-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA07730122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty