Provider Demographics
NPI:1578627238
Name:HARRIS, BRUCE STEWART (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:STEWART
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BRUCE
Other - Middle Name:STEWART
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2563 EVENING SKY DRIVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:949-275-1631
Mailing Address - Fax:714-964-4999
Practice Address - Street 1:2563 EVENING SKY DRIVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:949-275-1631
Practice Address - Fax:714-964-4999
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADJ196221223X0400X
CA196221223X0400X
NVS3-315C1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA952818849OtherTIN
CA953176812OtherTIN