Healthcare Provider Details

I. General information

NPI: 1609100478
Provider Name (Legal Business Name): JENNIFER DELEON HARMAN RDH, BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14979 W BELL RD STE 150
SURPRISE AZ
85374-3662
US

IV. Provider business mailing address

14979 W BELL RD STE 150
SURPRISE AZ
85374-3662
US

V. Phone/Fax

Practice location:
  • Phone: 623-476-5800
  • Fax:
Mailing address:
  • Phone: 623-476-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number6760
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number5647
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: