Provider Demographics
NPI:1437355708
Name:HARRIS, DAVID JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
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 1:51565 BITTERSWEET ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8859
Mailing Address - Country:US
Mailing Address - Phone:574-277-6637
Mailing Address - Fax:574-243-0075
Practice Address - Street 1:51565 BITTERSWEET ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8859
Practice Address - Country:US
Practice Address - Phone:574-277-6637
Practice Address - Fax:574-243-0075
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120059041223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery