Provider Demographics
NPI:1487858460
Name:BOB HARRIS DDS PA
Entity Type:Organization
Organization Name:BOB HARRIS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-277-2214
Mailing Address - Street 1:1 VANDERBILT PARK DRIVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1736
Mailing Address - Country:US
Mailing Address - Phone:828-277-2214
Mailing Address - Fax:828-277-2216
Practice Address - Street 1:1 VANDERBILT PARK DRIVE
Practice Address - Street 2:SUITE 220
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1736
Practice Address - Country:US
Practice Address - Phone:828-277-2214
Practice Address - Fax:828-277-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC51481223G0001X, 302R00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993632Medicaid
NC93632OtherBCBS
NC8993632Medicaid