Provider Demographics
NPI:1396835740
Name:HARRIS, HARRY OWEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:OWEN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 HOGUE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-1923
Mailing Address - Country:US
Mailing Address - Phone:770-684-5424
Mailing Address - Fax:770-684-0717
Practice Address - Street 1:701 HOGUE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ROCKMART
Practice Address - State:GA
Practice Address - Zip Code:30153-1923
Practice Address - Country:US
Practice Address - Phone:770-684-5424
Practice Address - Fax:770-684-0717
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0084221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice