Provider Demographics
NPI:1154328599
Name:HARRIS, BROWN III (DDS)
Entity type:Individual
Prefix:DR
First Name:BROWN
Middle Name:
Last Name:HARRIS
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SKIP
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:30012 N CAVE CREEK RD
Mailing Address - Street 2:STE 103
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-5833
Mailing Address - Country:US
Mailing Address - Phone:480-575-0844
Mailing Address - Fax:480-575-0845
Practice Address - Street 1:30012 N CAVE CREEK RD
Practice Address - Street 2:STE 103
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-5833
Practice Address - Country:US
Practice Address - Phone:480-575-0844
Practice Address - Fax:480-575-0845
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD57791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU96434Medicare UPIN