Provider Demographics
NPI:1316460009
Name:HARRIS, KAYCI M (DMD)
Entity type:Individual
Prefix:DR
First Name:KAYCI
Middle Name:M
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:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:EMBUDO
Mailing Address - State:NM
Mailing Address - Zip Code:87531-0037
Mailing Address - Country:US
Mailing Address - Phone:505-579-4680
Mailing Address - Fax:505-579-4074
Practice Address - Street 1:1102 STATE HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:EMBUDO
Practice Address - State:NM
Practice Address - Zip Code:87531
Practice Address - Country:US
Practice Address - Phone:505-579-4680
Practice Address - Fax:505-579-4074
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4761122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist