Provider Demographics
NPI:1609896570
Name:HARRIS, ROBERT L (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23071 EMERY RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5134
Mailing Address - Country:US
Mailing Address - Phone:216-591-1925
Mailing Address - Fax:216-591-1904
Practice Address - Street 1:23071 EMERY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5134
Practice Address - Country:US
Practice Address - Phone:216-591-1925
Practice Address - Fax:216-591-1904
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18327122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist