Provider Demographics
NPI:1730279589
Name:MICHAEL R HARRIS DDS PS
Entity Type:Organization
Organization Name:MICHAEL R HARRIS DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-789-2555
Mailing Address - Street 1:7715 24TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117
Mailing Address - Country:US
Mailing Address - Phone:206-789-2555
Mailing Address - Fax:206-706-6286
Practice Address - Street 1:7715 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117
Practice Address - Country:US
Practice Address - Phone:206-789-2555
Practice Address - Fax:206-706-6286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AH6173429OtherDRUG ENFORCEMENT ASSC
AH6173429OtherDRUG ENFORCEMENT ASSC