Provider Demographics
NPI:1871659839
Name:HARNESS, BRYAN G (DMD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:G
Last Name:HARNESS
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 1:1704 GAGEL AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216
Mailing Address - Country:US
Mailing Address - Phone:502-448-7703
Mailing Address - Fax:502-448-7703
Practice Address - Street 1:1704 GAGEL AVENUE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216
Practice Address - Country:US
Practice Address - Phone:502-448-7703
Practice Address - Fax:502-448-7703
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY69071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice