Provider Demographics
NPI:1851708796
Name:HARRIS, ERIC (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2792 S 5600 W STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-5590
Mailing Address - Country:US
Mailing Address - Phone:801-635-7740
Mailing Address - Fax:
Practice Address - Street 1:2792 S 5600 W STE 100
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84120-5590
Practice Address - Country:US
Practice Address - Phone:801-969-9669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00202242122300000X
UT6013345-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist