Provider Demographics
NPI:1801186770
Name:HARRIS, STEPHANIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
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:PO BOX 127B
Mailing Address - Street 2:
Mailing Address - City:WHITFIELD
Mailing Address - State:MS
Mailing Address - Zip Code:39193-1032
Mailing Address - Country:US
Mailing Address - Phone:601-664-6356
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 475 SOUTH
Practice Address - Street 2:
Practice Address - City:WHITFIELD
Practice Address - State:MS
Practice Address - Zip Code:39193-1032
Practice Address - Country:US
Practice Address - Phone:601-664-6356
Practice Address - Fax:601-664-6325
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS255190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist