MEDICARE: TORI LYNN HARMON DDS

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	1223G0001X	General Practice Dentistry	12012928A	IN
2	122300000X	Dentist	DDS-09608	IA

General Provider Information

NPI Number	:	1568957660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TORI LYNN HARMON DDS

Provider Business Mailing Address
First Line	:	1337 E 900 N
Second Line	:
City	:	CRAWFORDSVILLE
State	:	IN
Zip	:	47933-7320
Country	:	US
Telephone Number	:	765-376-4915
Fax Number	:

Provider Business Practice Location Address
First Line	:	2111 330TH AVE
Second Line	:
City	:	FORT MADISON
State	:	IA
Zip	:	52627-9783
Country	:	US
Telephone Number	:	543-231-9372
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2018
Last Update Date	:	03/02/2020

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