Provider Demographics
NPI:1194452375
Name:HARBOLT, MITCHELL T (DMD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:T
Last Name:HARBOLT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 WARNER MILNE RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4073
Mailing Address - Country:US
Mailing Address - Phone:971-206-7115
Mailing Address - Fax:
Practice Address - Street 1:365 WARNER MILNE RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4073
Practice Address - Country:US
Practice Address - Phone:971-206-7115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-06
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11664122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist