Provider Demographics
NPI:1578614152
Name:HARRIS DENTURE DESIGN INC
Entity Type:Organization
Organization Name:HARRIS DENTURE DESIGN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LD
Authorized Official - Phone:208-646-2211
Mailing Address - Street 1:22 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:ID
Mailing Address - Zip Code:83237-5094
Mailing Address - Country:US
Mailing Address - Phone:208-646-2211
Mailing Address - Fax:
Practice Address - Street 1:1 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:ID
Practice Address - Zip Code:83237-5115
Practice Address - Country:US
Practice Address - Phone:208-646-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLD -39122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty