MEDICARE: DR. SANDY 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	DS035921	PA

General Provider Information

NPI Number	:	1598748568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDY HARMON DDS

Provider Business Mailing Address
First Line	:	1412 FAIRMOUNT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-2908
Country	:	US
Telephone Number	:	215-599-4851
Fax Number	:	215-232-4093

Provider Business Practice Location Address
First Line	:	1412 FAIRMOUNT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-2908
Country	:	US
Telephone Number	:	215-235-9600
Fax Number	:	215-232-4093

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	09/02/2021

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