Provider Demographics
NPI:1366465445
Name:HARNICK, HARRIS D
Entity Type:Individual
Prefix:DR
First Name:HARRIS
Middle Name:D
Last Name:HARNICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 JOHN A CUMMINGS WAY
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3224
Mailing Address - Country:US
Mailing Address - Phone:401-769-1470
Mailing Address - Fax:401-762-8161
Practice Address - Street 1:25 JOHN A CUMMINGS WAY
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3224
Practice Address - Country:US
Practice Address - Phone:401-769-1470
Practice Address - Fax:401-762-8161
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI16821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIHH00090Medicare ID - Type UnspecifiedPROVIDER NUMBER