Provider Demographics
NPI:1053543819
Name:HARKER, JESSE WILSON (D D S)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:WILSON
Last Name:HARKER
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 LAKE HAVASU AVE S
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-9307
Mailing Address - Country:US
Mailing Address - Phone:928-855-8333
Mailing Address - Fax:928-855-8333
Practice Address - Street 1:371 LAKE HAVASU AVE S
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-9307
Practice Address - Country:US
Practice Address - Phone:928-855-8333
Practice Address - Fax:928-855-8333
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7857122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist