MEDICARE: HARMONY DENTAL OF SOUTHPORT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		NC

General Provider Information

NPI Number	:	1457485971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARMONY DENTAL OF SOUTHPORT

Provider Business Mailing Address
First Line	:	904 ALDEN BRIDGE DR
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27519-8321
Country	:	US
Telephone Number	:	919-468-9417
Fax Number	:

Provider Business Practice Location Address
First Line	:	4742 LONG BEACH RD SE
Second Line	:
City	:	SOUTHPORT
State	:	NC
Zip	:	28461-8721
Country	:	US
Telephone Number	:	910-457-7167
Fax Number	:

Authorized Official
Title or Position	:	DIRECT OWNER
Name	:	DR. JOHN WAYNE HOOKER
Credential	:	D.D.S.
Telephone Number	:	910-457-7167

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	08/22/2020

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