Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1245802305 |
---|---|
Provider Name | Erik Harmon |
First Address | Kailua, HI 96734-2616 |
Second Address | Kailua, HI 96734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2021 |
Last Update Date | 16/07/2021 |