Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 2901018094 | MI |
NPI | 1033324215 |
---|---|
Provider Name | Dr. Travis Quade Harshman |
First Address | Ionia, MI 48846-2132 |
Second Address | Ionia, MI 48846-2132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 18/04/2008 |