Provider Demographics
NPI:1396717344
Name:HARRIS, CHRISTINA ELAINE (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:ELAINE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21331 KELLY RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3265
Mailing Address - Country:US
Mailing Address - Phone:586-779-7600
Mailing Address - Fax:586-779-0018
Practice Address - Street 1:21331 KELLY RD
Practice Address - Street 2:SUITE 120
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3265
Practice Address - Country:US
Practice Address - Phone:586-779-7600
Practice Address - Fax:586-779-0018
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010162141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice