Provider Demographics
NPI:1053539239
Name:DR. JOHN P HARBOUR, D.D.S, M.S.D.
Entity type:Organization
Organization Name:DR. JOHN P HARBOUR, D.D.S, M.S.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:HARBOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-473-6434
Mailing Address - Street 1:200 RAILROAD AVENUE
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346
Mailing Address - Country:US
Mailing Address - Phone:225-473-6436
Mailing Address - Fax:225-927-1817
Practice Address - Street 1:200 RAILROAD AVENUE
Practice Address - Street 2:
Practice Address - City:DONALDSONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70346
Practice Address - Country:US
Practice Address - Phone:225-473-6436
Practice Address - Fax:225-927-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA32891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty