Provider Demographics
NPI:1154569762
Name:DOUGLAS E. HARSHBERGER, DDS, PC
Entity type:Organization
Organization Name:DOUGLAS E. HARSHBERGER, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PC
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HARSHBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-356-6020
Mailing Address - Street 1:5236 BLUE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-3061
Mailing Address - Country:US
Mailing Address - Phone:816-356-6020
Mailing Address - Fax:816-356-1606
Practice Address - Street 1:5236 BLUE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-3061
Practice Address - Country:US
Practice Address - Phone:816-356-6020
Practice Address - Fax:816-356-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0148641223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty