Provider Demographics
NPI:1659488765
Name:HARRIS AND HARRIS DMD PSC
Entity Type:Organization
Organization Name:HARRIS AND HARRIS DMD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-966-5252
Mailing Address - Street 1:5010 PRESTON HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213
Mailing Address - Country:US
Mailing Address - Phone:502-966-5252
Mailing Address - Fax:502-968-3342
Practice Address - Street 1:5010 PRESTON HWY
Practice Address - Street 2:100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213
Practice Address - Country:US
Practice Address - Phone:502-966-5252
Practice Address - Fax:502-968-3342
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARRIS AND HARRIS DMD PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-24
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60061602Medicaid