Provider Demographics
NPI:1609045830
Name:HARRISS FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:HARRISS FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HARRISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-379-7004
Mailing Address - Street 1:712 MORGANTON SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-4797
Mailing Address - Country:US
Mailing Address - Phone:865-379-7004
Mailing Address - Fax:
Practice Address - Street 1:712 MORGANTON SQUARE DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-4797
Practice Address - Country:US
Practice Address - Phone:865-379-7004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN79851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty