Provider Demographics
NPI:1104966365
Name:HARRIS, STEPHEN ARTHUR (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ARTHUR
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 CENTRAL AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-4758
Mailing Address - Country:US
Mailing Address - Phone:518-869-9453
Mailing Address - Fax:518-869-9837
Practice Address - Street 1:1735 CENTRAL AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-4758
Practice Address - Country:US
Practice Address - Phone:518-869-9453
Practice Address - Fax:518-869-9837
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY141692508OtherTIN