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General NPI Number Information
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NPI Number | 1033324215
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Entity Type | Individual
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Provider Name | TRAVIS QUADE HARSHMAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 1978 S STATE RD
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City | IONIA
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State | MI
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Zip | 48846-2132
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Country | US
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Telephone | 616-527-0030
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Fax | 616-527-4722
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Provider Business Mailing Address
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Address Line | 1978 S STATE RD
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City | IONIA
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State | MI
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Zip | 48846-2132
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Country | US
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Telephone | 616-527-0030
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Fax | 616-527-4722
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2901018094
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License Number State | MI
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