Provider Demographics
NPI:1881676351
Name:HARRIS, ANDREW BENNETT (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:BENNETT
Last Name:HARRIS
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 1:809 HAMILTON XING
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-8408
Mailing Address - Country:US
Mailing Address - Phone:615-942-6898
Mailing Address - Fax:615-942-8670
Practice Address - Street 1:809 HAMILTON XING
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-8408
Practice Address - Country:US
Practice Address - Phone:615-942-6898
Practice Address - Fax:615-942-8670
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS7452122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440162Medicaid