Healthcare Provider Details

I. General information

NPI: 1992868921
Provider Name (Legal Business Name): HARMS-TRI DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 1ST ST
FARMINGTON MN
55024-1003
US

IV. Provider business mailing address

213 1ST ST
FARMINGTON MN
55024-1003
US

V. Phone/Fax

Practice location:
  • Phone: 651-463-7777
  • Fax: 651-460-6123
Mailing address:
  • Phone: 651-463-7777
  • Fax: 651-460-6123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12385
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9838
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9839
License Number StateMN

VIII. Authorized Official

Name: DR. JAMES ROGER HARMS
Title or Position: PRESIDENT
Credential: DDS
Phone: 651-463-7777