Healthcare Provider Details

I. General information

NPI: 1760596761
Provider Name (Legal Business Name): JAY A. HARLAN, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 S WALKER AVE SUITE E
OKLAHOMA CITY OK
73139-9418
US

IV. Provider business mailing address

8101 S WALKER AVE SUITE E
OKLAHOMA CITY OK
73139-9418
US

V. Phone/Fax

Practice location:
  • Phone: 405-632-9726
  • Fax: 405-632-9728
Mailing address:
  • Phone: 405-632-9726
  • Fax: 405-632-9728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5092
License Number StateOK

VIII. Authorized Official

Name: DR. JAY ALAN HARLAN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 405-632-9726