Healthcare Provider Details

I. General information

NPI: 1346449501
Provider Name (Legal Business Name): ROBERT JOHN HARAY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 COCHECTON TURNPIKE
DAMASCUS PA
18415-0105
US

IV. Provider business mailing address

PO BOX 105 1731 COCHECTON TURNPIKE
DAMASCUS PA
18415-0105
US

V. Phone/Fax

Practice location:
  • Phone: 570-224-6700
  • Fax: 570-224-6649
Mailing address:
  • Phone: 570-224-6700
  • Fax: 570-224-6649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS026248L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: