Provider Demographics
NPI:1790728186
Name:HARRIS, MARION LAWRENCE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:LAWRENCE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 MURPHY MILL RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1521
Mailing Address - Country:US
Mailing Address - Phone:334-793-9888
Mailing Address - Fax:334-793-7730
Practice Address - Street 1:2601 MURPHY MILL RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1521
Practice Address - Country:US
Practice Address - Phone:334-793-9888
Practice Address - Fax:334-793-7730
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL32141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice