Provider Demographics
NPI:1558043042
Name:LANCE HARRIS PLLC
Entity Type:Organization
Organization Name:LANCE HARRIS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:760-213-2739
Mailing Address - Street 1:21072 NORDBY DR NW
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6639
Mailing Address - Country:US
Mailing Address - Phone:760-213-2739
Mailing Address - Fax:
Practice Address - Street 1:18825 CALDART AVE NE STE B
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8714
Practice Address - Country:US
Practice Address - Phone:760-213-2739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental