Provider Demographics
NPI:1629945548
Name:HARRIS DENTAL LLC
Entity type:Organization
Organization Name:HARRIS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COSTAS
Authorized Official - Middle Name:V
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-978-9207
Mailing Address - Street 1:325 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-2407
Mailing Address - Country:US
Mailing Address - Phone:973-676-3700
Mailing Address - Fax:973-676-3701
Practice Address - Street 1:325 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-2407
Practice Address - Country:US
Practice Address - Phone:973-676-3700
Practice Address - Fax:973-676-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-23
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty