Provider Demographics
NPI:1306904487
Name:HARRIS, KAREN JEANNE (DMD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:JEANNE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103
Mailing Address - Country:US
Mailing Address - Phone:314-231-4893
Mailing Address - Fax:314-231-0183
Practice Address - Street 1:2000 LOCUST ST
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103
Practice Address - Country:US
Practice Address - Phone:314-231-4893
Practice Address - Fax:314-231-0183
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO140481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice