Provider Demographics
NPI:1427157288
Name:HARRIS, MICHAEL EUGENE (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EUGENE
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 1:421 N 38TH ST
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-4153
Mailing Address - Country:US
Mailing Address - Phone:254-634-0234
Mailing Address - Fax:254-634-0234
Practice Address - Street 1:421 N 38TH ST
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-4153
Practice Address - Country:US
Practice Address - Phone:254-634-0234
Practice Address - Fax:254-634-0234
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice