Provider Demographics
NPI:1013452788
Name:MICHAEL S. HARRIS DMD
Entity Type:Organization
Organization Name:MICHAEL S. HARRIS DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-204-3242
Mailing Address - Street 1:12794 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 27A
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4710
Mailing Address - Country:US
Mailing Address - Phone:561-204-3242
Mailing Address - Fax:561-204-3243
Practice Address - Street 1:12794 FOREST HILL BLVD
Practice Address - Street 2:SUITE 27A
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4710
Practice Address - Country:US
Practice Address - Phone:561-204-3242
Practice Address - Fax:561-204-3243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty