Provider Demographics
NPI:1770511396
Name:HARRIS, GRANT PHILIP (DDS)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:PHILIP
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 E FULTON TER
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-6151
Mailing Address - Country:US
Mailing Address - Phone:620-276-7623
Mailing Address - Fax:
Practice Address - Street 1:218 E FULTON TER
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-6151
Practice Address - Country:US
Practice Address - Phone:620-276-7623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60197122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist