Provider Demographics
NPI:1699214452
Name:HARRIS, KELLY UYEN (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:UYEN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:4413 LEMONGRASS DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-8176
Mailing Address - Country:US
Mailing Address - Phone:714-417-1713
Mailing Address - Fax:
Practice Address - Street 1:4413 LEMONGRASS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-8176
Practice Address - Country:US
Practice Address - Phone:714-417-1713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN211281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics