Provider Demographics
NPI:1972647485
Name:HARRIS, CAROLYN MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:MARIE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 NAPOLEON AVE
Mailing Address - Street 2:SUITE 702
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6357
Mailing Address - Country:US
Mailing Address - Phone:504-891-9264
Mailing Address - Fax:504-891-9264
Practice Address - Street 1:2633 NAPOLEON AVE
Practice Address - Street 2:SUITE 702
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6357
Practice Address - Country:US
Practice Address - Phone:504-891-9264
Practice Address - Fax:504-891-9264
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA41871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAA2033OtherBLUE CROSS PROVIDER
LA1841871Medicaid
LA4187OtherLOUISIANA DENTAL LICENSE
LA3724677OtherEMPLOYER'S STATE ID