Provider Demographics
NPI:1528725249
Name:HARMAN, RICHARD JR (RDH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:HARMAN
Suffix:JR
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 EVERGREEN AVE NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1616
Mailing Address - Country:US
Mailing Address - Phone:703-881-6214
Mailing Address - Fax:
Practice Address - Street 1:631 JASON ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2357
Practice Address - Country:US
Practice Address - Phone:703-881-6214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
ORH7753124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist