Provider Demographics
NPI:1255445250
Name:HARLAN, JAY ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:ALAN
Last Name:HARLAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8101 S WALKER AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9418
Mailing Address - Country:US
Mailing Address - Phone:405-632-9726
Mailing Address - Fax:405-632-9728
Practice Address - Street 1:8101 S WALKER AVE
Practice Address - Street 2:SUITE E
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9418
Practice Address - Country:US
Practice Address - Phone:405-632-9726
Practice Address - Fax:405-632-9728
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK50921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery