Healthcare Provider Details

I. General information

NPI: 1568957660
Provider Name (Legal Business Name): TORI LYNN HARMON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2018
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 330TH AVE
FORT MADISON IA
52627-9783
US

IV. Provider business mailing address

1337 E 900 N
CRAWFORDSVILLE IN
47933-7320
US

V. Phone/Fax

Practice location:
  • Phone: 543-231-9372
  • Fax:
Mailing address:
  • Phone: 765-376-4915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS-09608
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12012928A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: