Provider Demographics
NPI:1205957594
Name:HARPER, MARY ALLISON (DMD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ALLISON
Last Name:HARPER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9940 N COUNTY HWY K
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-2186
Mailing Address - Country:US
Mailing Address - Phone:715-638-5144
Mailing Address - Fax:715-634-9919
Practice Address - Street 1:9940 N COUNTY HWY K
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-2186
Practice Address - Country:US
Practice Address - Phone:715-638-5144
Practice Address - Fax:715-634-9919
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN175481223G0001X
ID69871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1205957594Medicaid
ID807490600Medicaid