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General NPI Number Information
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NPI Number | 1952788150
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Entity Type | Organization
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Legal Business Name | DAVID J HARALSON
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Dates
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Enumeration Date | 04/27/2015
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 509 OLIVE WAY STE 1331
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City | SEATTLE
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State | WA
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Zip | 98101-1743
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Country | US
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Telephone | 206-624-0852
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Fax |
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Provider Business Mailing Address
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Address Line | 509 OLIVE WAY STE 1331
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City | SEATTLE
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State | WA
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Zip | 98101-1743
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Country | US
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Telephone | 206-624-0852
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Fax |
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Authorized Official
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Title or Position | OWNER/MD, DMD
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Name | DAVID HARALSON
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Credential |
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Telephone | 206-624-0852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DE60295571
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License Number State | WA
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