MEDICARE: HARMONY DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	602839713	WA

General Provider Information

NPI Number	:	1114470812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARMONY DENTAL

Provider Business Mailing Address
First Line	:	291 C ST UNIT 112
Second Line	:
City	:	WASHOUGAL
State	:	WA
Zip	:	98671-2168
Country	:	US
Telephone Number	:	360-844-6344
Fax Number	:	360-844-6333

Provider Business Practice Location Address
First Line	:	291 C ST UNIT 112
Second Line	:
City	:	WASHOUGAL
State	:	WA
Zip	:	98671-2168
Country	:	US
Telephone Number	:	360-844-6344
Fax Number	:	360-844-6333

Authorized Official
Title or Position	:	OWNER
Name	:	SUPRIYA GOVERDHANAM
Credential	:
Telephone Number	:	360-844-6344

Provider Enumeration Date	:	07/28/2016
Last Update Date	:	07/28/2016

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Directions to “HARMONY DENTAL ” Practice Location

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