Provider Demographics
NPI:1487712030
Name:HARMON, MIMI BUTTERFLY (DDS)
Entity type:Individual
Prefix:DR
First Name:MIMI
Middle Name:BUTTERFLY
Last Name:HARMON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:PILAR
Other - Last Name:PALOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2000 BOCA CHICA BLVD.
Mailing Address - Street 2:STE 300
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521
Mailing Address - Country:US
Mailing Address - Phone:956-550-9982
Mailing Address - Fax:956-550-9519
Practice Address - Street 1:2000 BOCA CHICA BLVD.
Practice Address - Street 2:STE 300
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521
Practice Address - Country:US
Practice Address - Phone:956-550-9982
Practice Address - Fax:956-550-9519
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX190871223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist