Organization
TIMOTHY R. HARBOLT, DMD
Active
Other names
Family Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY R. HARBOLT D.M.D. (PRESIDENT)
(503) 551-6349
Entity
Organization
Contact information
Practice address
4734 RIVER RD N, KEIZER, OR 97303-4536
(503) 463-4663
(503) 463-4666
Mailing address
4734 RIVER RD N, KEIZER, OR 97303-4536
(503) 463-4663
(503) 463-4666
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D6816
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D6816
STATE LICENSE NUMBER
OR
Enumeration date
07/07/2005
Last updated
09/10/2012
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