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NPI Code Detail

MEDICARE: DR. BRYAN WAYNE HARBER D.D.S.

MEDICARE: DR. BRYAN WAYNE HARBER D.D.S.
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
11223G0001XGeneral Practice DentistryDE00010742WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396851127
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRYAN WAYNE HARBER D.D.S.
Provider Business Mailing Address
First Line : PO BOX 160
Second Line :
City : SHIPROCK
State : NM
Zip : 87420-0160
Country : US
Telephone Number : 505-632-1801
Fax Number :
Provider Business Practice Location Address
First Line : 6 ROAD 7586
Second Line :
City : BLOOMFIELD
State : NM
Zip : 87413-4934
Country : US
Telephone Number : 505-632-1801
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2006
Last Update Date : 10/17/2008

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