Provider Demographics
NPI:1184054512
Name:HARRIS, MICHAEL ALVIN (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALVIN
Last Name:HARRIS
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 1:398 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:AMBRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15003-2518
Mailing Address - Country:US
Mailing Address - Phone:724-266-1209
Mailing Address - Fax:724-266-3427
Practice Address - Street 1:398 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:AMBRIDGE
Practice Address - State:PA
Practice Address - Zip Code:15003-2518
Practice Address - Country:US
Practice Address - Phone:724-266-1209
Practice Address - Fax:724-266-3427
Is Sole Proprietor?:No
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018917L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist