Healthcare Provider Details

I. General information

NPI: 1942712922
Provider Name (Legal Business Name): HARMONY PEDIATRIC DENTAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37515 SE HWY 26
SANDY OR
97055
US

IV. Provider business mailing address

3605 GRANT DR
RENO NV
89509-5301
US

V. Phone/Fax

Practice location:
  • Phone: 503-912-6255
  • Fax:
Mailing address:
  • Phone: 775-409-4614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NATE ROCKWELL
Title or Position: CPA
Credential:
Phone: 775-336-1510