Provider Demographics
NPI:1699798462
Name:HARRIS, STEVEN LAWRENCE (DMD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LAWRENCE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4303
Mailing Address - Country:US
Mailing Address - Phone:270-442-1077
Mailing Address - Fax:270-442-2553
Practice Address - Street 1:3011 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4303
Practice Address - Country:US
Practice Address - Phone:270-442-1077
Practice Address - Fax:270-442-2553
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY59781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice