Healthcare Provider Details

I. General information

NPI: 1205830130
Provider Name (Legal Business Name): LAUREN F HARMON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2819 LONGVIEW DR
JONESBORO AR
72401-5919
US

IV. Provider business mailing address

2819 LONGVIEW DR
JONESBORO AR
72401-5919
US

V. Phone/Fax

Practice location:
  • Phone: 870-932-3151
  • Fax: 870-972-5060
Mailing address:
  • Phone: 870-932-3151
  • Fax: 870-972-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3391
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: