Provider Demographics
NPI:1689886822
Name:HARRIS, DALILA (DMD)
Entity Type:Individual
Prefix:DR
First Name:DALILA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13650 W COLONIAL DR STE 120A
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3993
Mailing Address - Country:US
Mailing Address - Phone:407-905-5698
Mailing Address - Fax:407-905-0513
Practice Address - Street 1:13650 W COLONIAL DR STE 120A
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3993
Practice Address - Country:US
Practice Address - Phone:407-905-5698
Practice Address - Fax:407-905-0513
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16356122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN16356Medicare UPIN