Provider Demographics
NPI:1215243985
Name:DR. DAVID J HARNICK D.D.S.,M.S.D.
Entity type:Organization
Organization Name:DR. DAVID J HARNICK D.D.S.,M.S.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:505-831-1600
Mailing Address - Street 1:8631 GOLF COURSE RD NW STE F
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6347
Mailing Address - Country:US
Mailing Address - Phone:505-831-1600
Mailing Address - Fax:505-899-0408
Practice Address - Street 1:8631 GOLF COURSE RD NW STE F
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-6347
Practice Address - Country:US
Practice Address - Phone:505-831-1600
Practice Address - Fax:505-899-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1141261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental