Provider Demographics
NPI:1063514420
Name:HARRIS, STEPHEN R (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:HARRIS
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 1:34024 W 8 MILE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-5209
Mailing Address - Country:US
Mailing Address - Phone:248-478-4755
Mailing Address - Fax:248-478-1139
Practice Address - Street 1:34024 W 8 MILE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-5209
Practice Address - Country:US
Practice Address - Phone:248-478-4755
Practice Address - Fax:248-478-1139
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010136071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice