Provider Demographics
NPI:1215049259
Name:HARRIS, HARVEY J (DDS)
Entity type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:J
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 1:4157 HUNT RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-1158
Mailing Address - Country:US
Mailing Address - Phone:513-791-6154
Mailing Address - Fax:513-791-1449
Practice Address - Street 1:4157 HUNT RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-1158
Practice Address - Country:US
Practice Address - Phone:513-791-6154
Practice Address - Fax:513-791-1449
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH132851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0148316Medicaid