Provider Demographics
NPI:1215196977
Name:HARRIS, KRISTIN JANELL (DMD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:JANELL
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:JANELL
Other - Last Name:DUFFY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2369
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-2369
Mailing Address - Country:US
Mailing Address - Phone:256-741-7340
Mailing Address - Fax:256-741-7373
Practice Address - Street 1:3438 TAYLOR BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-2648
Practice Address - Country:US
Practice Address - Phone:502-366-4442
Practice Address - Fax:502-366-4446
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY86021223G0001X
OH300229711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice