Provider Demographics
NPI:1477728814
Name:HARRIS, CHAD A (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:A
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 1:320 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-1410
Mailing Address - Country:US
Mailing Address - Phone:570-748-4131
Mailing Address - Fax:570-748-2095
Practice Address - Street 1:320 E WATER ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-1410
Practice Address - Country:US
Practice Address - Phone:570-748-4131
Practice Address - Fax:570-748-2095
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO356151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice