Provider Demographics
NPI:1346366846
Name:HARRISS, MOLLY K (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:K
Last Name:HARRISS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 MORGANTON SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-4797
Mailing Address - Country:US
Mailing Address - Phone:865-379-7004
Mailing Address - Fax:865-379-7040
Practice Address - Street 1:712 MORGANTON SQUARE DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-4797
Practice Address - Country:US
Practice Address - Phone:865-379-7004
Practice Address - Fax:865-379-7040
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN79851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice