Provider Demographics
NPI:1487842001
Name:HARRIS, SCOTT RICHARD (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:RICHARD
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20261 E OCOTILLO RD
Mailing Address - Street 2:SUITE #120
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85242-8806
Mailing Address - Country:US
Mailing Address - Phone:480-987-8768
Mailing Address - Fax:480-987-5676
Practice Address - Street 1:20261 E OCOTILLO RD
Practice Address - Street 2:SUITE #120
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85242-8806
Practice Address - Country:US
Practice Address - Phone:480-987-8768
Practice Address - Fax:480-987-5676
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ72771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice