Provider Demographics
NPI:1275668188
Name:HARRIS, KEVIN M (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
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 1:38252 N JACQUELINE DR
Mailing Address - Street 2:SUITE # E
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-9553
Mailing Address - Country:US
Mailing Address - Phone:480-595-5966
Mailing Address - Fax:480-595-5988
Practice Address - Street 1:38252 N JACQUELINE DR
Practice Address - Street 2:SUITE # E
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-9553
Practice Address - Country:US
Practice Address - Phone:480-595-5966
Practice Address - Fax:480-595-5988
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ39491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice