Provider Demographics
NPI:1326411042
Name:STEPHEN R HARRIS DDS, PC
Entity Type:Organization
Organization Name:STEPHEN R HARRIS DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-478-4755
Mailing Address - Street 1:34024 W 8 MILE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-5209
Mailing Address - Country:US
Mailing Address - Phone:248-478-4755
Mailing Address - Fax:248-478-1139
Practice Address - Street 1:34024 W 8 MILE RD STE 106
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-5209
Practice Address - Country:US
Practice Address - Phone:248-478-4755
Practice Address - Fax:248-478-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013607122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty