Provider Demographics
NPI:1548551989
Name:HARPER, KATIE LYNN (DMD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:HARPER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 NE 20TH AVE STE B200
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-6412
Mailing Address - Country:US
Mailing Address - Phone:360-571-8181
Mailing Address - Fax:
Practice Address - Street 1:10535 NE GLISAN ST STE 301
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220
Practice Address - Country:US
Practice Address - Phone:503-444-2824
Practice Address - Fax:503-444-2823
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD98761223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
500661580OtherDMAP