Provider Demographics
NPI:1689700031
Name:HARRIS, KEVIN PAUL (DDS, PC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:PAUL
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3488 BRENTWOOD DR STE 103
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2015
Mailing Address - Country:US
Mailing Address - Phone:225-930-4785
Mailing Address - Fax:225-930-4785
Practice Address - Street 1:3488 BRENTWOOD DR STE 103
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2015
Practice Address - Country:US
Practice Address - Phone:225-930-4785
Practice Address - Fax:225-930-4785
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2023-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4833122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics