Provider Demographics
NPI:1154879625
Name:HARMON, TRACY LYNN (RDH)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:HARMON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLD 4431 68TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76549
Mailing Address - Country:US
Mailing Address - Phone:254-287-1225
Mailing Address - Fax:254-287-9685
Practice Address - Street 1:BLDG 39033 SUPPORT AVE
Practice Address - Street 2:DENTAL CLINIC 3 FORT HOOD
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-287-1225
Practice Address - Fax:254-287-9685
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1901124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist