Provider Demographics
NPI:1063850642
Name:MICHAEL D. HARRIS DMD, P. C.
Entity type:Organization
Organization Name:MICHAEL D. HARRIS DMD, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-747-9830
Mailing Address - Street 1:3314 GATEWAY ST
Mailing Address - Street 2:CROSSROADS CENTER
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1054
Mailing Address - Country:US
Mailing Address - Phone:541-747-9830
Mailing Address - Fax:252-208-7065
Practice Address - Street 1:3314 GATEWAY ST
Practice Address - Street 2:CROSSROADS CENTER
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1054
Practice Address - Country:US
Practice Address - Phone:541-747-9830
Practice Address - Fax:252-208-7065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8580122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty