Provider Demographics
NPI:1366701005
Name:HARNER, LORI E (RDHAP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:E
Last Name:HARNER
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 113
Mailing Address - Street 2:
Mailing Address - City:ROUND MOUNTAIN
Mailing Address - State:CA
Mailing Address - Zip Code:96084-0113
Mailing Address - Country:US
Mailing Address - Phone:530-472-1958
Mailing Address - Fax:530-472-1335
Practice Address - Street 1:27850 BULLSKIN RIDGE RD
Practice Address - Street 2:
Practice Address - City:OAK RUN
Practice Address - State:CA
Practice Address - Zip Code:96069-9504
Practice Address - Country:US
Practice Address - Phone:530-472-1958
Practice Address - Fax:530-472-1335
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist