Provider Demographics
NPI:1134224710
Name:HARLESS, ANTHONY D (DDS)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:D
Last Name:HARLESS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 NE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-1111
Mailing Address - Country:US
Mailing Address - Phone:937-544-3239
Mailing Address - Fax:937-544-7165
Practice Address - Street 1:818 NE MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-1111
Practice Address - Country:US
Practice Address - Phone:937-544-3239
Practice Address - Fax:937-544-7165
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH212751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2196832Medicaid