Provider Demographics
NPI:1699764670
Name:HARKACZ, OREST MYCHAJLO SR (DDS)
Entity type:Individual
Prefix:DR
First Name:OREST
Middle Name:MYCHAJLO
Last Name:HARKACZ
Suffix:SR
Gender:M
Credentials:DDS
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 672412
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-2412
Mailing Address - Country:US
Mailing Address - Phone:907-688-2517
Mailing Address - Fax:
Practice Address - Street 1:4001 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5211
Practice Address - Country:US
Practice Address - Phone:907-334-9995
Practice Address - Fax:907-334-9951
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11491223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics