Provider Demographics
NPI:1770672503
Name:HARSHA, BRIAN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:C
Last Name:HARSHA
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 1:133 TOWNE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579
Mailing Address - Country:US
Mailing Address - Phone:843-448-1621
Mailing Address - Fax:843-903-3840
Practice Address - Street 1:133 TOWNE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579
Practice Address - Country:US
Practice Address - Phone:843-448-1621
Practice Address - Fax:843-903-3840
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2724-03351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ27249Medicaid
SCZ27249Medicaid