Provider Demographics
NPI:1164538252
Name:HARRIS, MARK LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEE
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 1:5406 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:GAP
Mailing Address - State:PA
Mailing Address - Zip Code:17527
Mailing Address - Country:US
Mailing Address - Phone:717-442-9488
Mailing Address - Fax:
Practice Address - Street 1:5406 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:GAP
Practice Address - State:PA
Practice Address - Zip Code:17527
Practice Address - Country:US
Practice Address - Phone:717-442-9488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS# 024108-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice