Provider Demographics
NPI:1518080712
Name:SPUR CROSS DENTAL SPA
Entity Type:Organization
Organization Name:SPUR CROSS DENTAL SPA
Other - Org Name:KEVIN M. HARRIS DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-595-5966
Mailing Address - Street 1:38252 N JACQUELINE DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-9553
Mailing Address - Country:US
Mailing Address - Phone:480-595-5966
Mailing Address - Fax:480-595-5988
Practice Address - Street 1:38252 N JACQUELINE DR
Practice Address - Street 2:SUITE E
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-9553
Practice Address - Country:US
Practice Address - Phone:480-595-5966
Practice Address - Fax:480-595-5988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ39491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty