Provider Demographics
NPI:1396816898
Name:HARRIS, WYATT ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:WYATT
Middle Name:ANDREW
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 1:204 PIRIE RD # B
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3135
Mailing Address - Country:US
Mailing Address - Phone:805-646-1603
Mailing Address - Fax:805-646-2223
Practice Address - Street 1:204 PIRIE RD # B
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3135
Practice Address - Country:US
Practice Address - Phone:805-646-1603
Practice Address - Fax:805-646-2223
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA233171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice