Provider Demographics
NPI:1982820569
Name:HARRIS, RUSSELL S (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:S
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 1:2 EMBARCADERO CTR
Mailing Address - Street 2:PROMENADE LEVEL
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3823
Mailing Address - Country:US
Mailing Address - Phone:415-398-4400
Mailing Address - Fax:415-398-1748
Practice Address - Street 1:2 EMBARCADERO CTR
Practice Address - Street 2:PROMENADE LEVEL
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-3823
Practice Address - Country:US
Practice Address - Phone:415-398-4400
Practice Address - Fax:415-398-1748
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA528621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice