Provider Demographics
NPI:1932199601
Name:HARRIS, ETHEL P (DDS)
Entity type:Individual
Prefix:DR
First Name:ETHEL
Middle Name:P
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 1:2802 BRANSFORD AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3102
Mailing Address - Country:US
Mailing Address - Phone:615-783-0142
Mailing Address - Fax:615-783-0143
Practice Address - Street 1:2802 BRANSFORD AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3102
Practice Address - Country:US
Practice Address - Phone:615-783-0142
Practice Address - Fax:615-783-0143
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000079261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice