Provider Demographics
NPI:1659595072
Name:DANIEL W. HARRIS, D.D.S, P.A.
Entity Type:Organization
Organization Name:DANIEL W. HARRIS, D.D.S, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-746-2161
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:AYDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28513-0487
Mailing Address - Country:US
Mailing Address - Phone:252-746-2161
Mailing Address - Fax:252-746-7412
Practice Address - Street 1:206 3RD ST
Practice Address - Street 2:
Practice Address - City:AYDEN
Practice Address - State:NC
Practice Address - Zip Code:28513-2234
Practice Address - Country:US
Practice Address - Phone:252-746-2161
Practice Address - Fax:252-746-7412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993634Medicaid