Provider Demographics
NPI:1699751560
Name:HARLESS, HELEN HALLQUIST (DDS)
Entity type:Individual
Prefix:DR
First Name:HELEN
Middle Name:HALLQUIST
Last Name:HARLESS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:HELEN
Other - Middle Name:MARLA
Other - Last Name:HALLQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1201 S FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1304
Mailing Address - Country:US
Mailing Address - Phone:208-322-5655
Mailing Address - Fax:208-323-8160
Practice Address - Street 1:1201 S FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1304
Practice Address - Country:US
Practice Address - Phone:208-322-5655
Practice Address - Fax:208-323-8160
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-43041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice