Provider Demographics
NPI:1023205937
Name:HARRIS, ARTHUR MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:MARK
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 1:27115 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-2900
Mailing Address - Country:US
Mailing Address - Phone:586-771-5880
Mailing Address - Fax:586-771-5882
Practice Address - Street 1:27115 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-2900
Practice Address - Country:US
Practice Address - Phone:586-771-5880
Practice Address - Fax:586-771-5882
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI145021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice