Healthcare Provider Details

I. General information

NPI: 1740361559
Provider Name (Legal Business Name): STEPHEN J HARKINS DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4781 E CAMP LOWELL DR STE 101
TUCSON AZ
85712-1290
US

IV. Provider business mailing address

4781 E CAMP LOWELL DR STE 101
TUCSON AZ
85712-1290
US

V. Phone/Fax

Practice location:
  • Phone: 520-298-6909
  • Fax: 520-298-7376
Mailing address:
  • Phone: 520-298-6909
  • Fax: 520-298-7376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD2775
License Number StateAZ

VIII. Authorized Official

Name: DR. STEPHEN J HARKINS
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 520-298-6909