Provider Demographics
NPI:1972751923
Name:HAREID, KATIE LEAH (DDS)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:LEAH
Last Name:HAREID
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:LEAH
Other - Last Name:HAREID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:ELOY
Mailing Address - State:AZ
Mailing Address - Zip Code:85231-0606
Mailing Address - Country:US
Mailing Address - Phone:520-466-3920
Mailing Address - Fax:
Practice Address - Street 1:3130 N TOLTEC RD
Practice Address - Street 2:
Practice Address - City:ELOY
Practice Address - State:AZ
Practice Address - Zip Code:85231-9617
Practice Address - Country:US
Practice Address - Phone:520-466-3920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD75981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice