Provider Demographics
NPI:1043418825
Name:HARRIS, SUZAN VANNELLA (DDS)
Entity Type:Individual
Prefix:
First Name:SUZAN
Middle Name:VANNELLA
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 1:2300 E RANCIER AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-3450
Mailing Address - Country:US
Mailing Address - Phone:254-781-8177
Mailing Address - Fax:
Practice Address - Street 1:2300 E RANCIER AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543
Practice Address - Country:US
Practice Address - Phone:254-781-8177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice