Provider Demographics
NPI:1295046217
Name:HARRIS, DOUGLAS W, (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:W,
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 1:190 W LOWRY LN
Mailing Address - Street 2:STE 100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3024
Mailing Address - Country:US
Mailing Address - Phone:859-276-4200
Mailing Address - Fax:859-278-3213
Practice Address - Street 1:190 W LOWRY LN
Practice Address - Street 2:STE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3024
Practice Address - Country:US
Practice Address - Phone:859-276-4200
Practice Address - Fax:859-278-3213
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8912122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist