Provider Demographics
NPI:1316767759
Name:HARMON, DESIREE (RDH)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
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 1:2492 290TH AVE
Mailing Address - Street 2:
Mailing Address - City:HILL CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67642-2809
Mailing Address - Country:US
Mailing Address - Phone:785-421-7012
Mailing Address - Fax:
Practice Address - Street 1:2492 290TH AVE
Practice Address - Street 2:
Practice Address - City:HILL CITY
Practice Address - State:KS
Practice Address - Zip Code:67642-2809
Practice Address - Country:US
Practice Address - Phone:785-421-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12995124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist