Provider Demographics
NPI:1295848372
Name:HARRIS, MICHAEL ROBERT (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROBERT
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 1:7715 24TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-4412
Mailing Address - Country:US
Mailing Address - Phone:206-789-2555
Mailing Address - Fax:206-706-6286
Practice Address - Street 1:7715 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-4412
Practice Address - Country:US
Practice Address - Phone:206-789-2555
Practice Address - Fax:206-706-6286
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AH6173429OtherDRUG ENFORCEMENT ASSOC
WA5372909Medicare ID - Type Unspecified