Provider Demographics
NPI:1023738861
Name:HARMON AND OTTESON DENTAL DURANGO LLC
Entity type:Organization
Organization Name:HARMON AND OTTESON DENTAL DURANGO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-669-1254
Mailing Address - Street 1:5205 S DURANGO DR STE 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-0179
Mailing Address - Country:US
Mailing Address - Phone:765-669-1254
Mailing Address - Fax:
Practice Address - Street 1:5205 S DURANGO DR STE 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-0179
Practice Address - Country:US
Practice Address - Phone:765-669-1254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental