Provider Demographics
NPI:1073759304
Name:HARRIS, STACEY CAMERON (DDS)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:CAMERON
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977 STATE HIGHWAY 121
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6016
Mailing Address - Country:US
Mailing Address - Phone:972-727-4800
Mailing Address - Fax:972-727-4802
Practice Address - Street 1:977 STATE HIGHWAY 121
Practice Address - Street 2:SUITE 190
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6016
Practice Address - Country:US
Practice Address - Phone:972-727-4800
Practice Address - Fax:972-727-4802
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice