Provider Demographics
NPI:1164706347
Name:HARRIS, TERANI ROSE (RDH, DT, ADT)
Entity Type:Individual
Prefix:MRS
First Name:TERANI
Middle Name:ROSE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RDH, DT, ADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2822 SILVER FOX CIR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-5834
Mailing Address - Country:US
Mailing Address - Phone:218-428-0869
Mailing Address - Fax:
Practice Address - Street 1:601 HIGHWAY 73
Practice Address - Street 2:
Practice Address - City:FLOODWOOD
Practice Address - State:MN
Practice Address - Zip Code:55736-8450
Practice Address - Country:US
Practice Address - Phone:218-476-2969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11055-016124Q00000X
MNH8920124Q00000X
MNDT69125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125K00000XDental ProvidersAdvanced Practice Dental Therapist
No124Q00000XDental ProvidersDental Hygienist