Provider Demographics
NPI:1346099033
Name:HARL FAMILY DENTISTRY
Entity type:Organization
Organization Name:HARL FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNING DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:HARL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-443-5195
Mailing Address - Street 1:1100 CLUB VILLAGE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4411
Mailing Address - Country:US
Mailing Address - Phone:573-443-5195
Mailing Address - Fax:
Practice Address - Street 1:1100 CLUB VILLAGE DR STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4411
Practice Address - Country:US
Practice Address - Phone:573-443-5195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty