Provider Demographics
NPI:1184356495
Name:HARRIS DENTAL CENTERVILLE (HDC), L.L.C.
Entity type:Organization
Organization Name:HARRIS DENTAL CENTERVILLE (HDC), L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-362-4885
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:BARNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:02630-0487
Mailing Address - Country:US
Mailing Address - Phone:508-362-4885
Mailing Address - Fax:508-362-0219
Practice Address - Street 1:1645 FALMOUTH RD STE 4B
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02632-2934
Practice Address - Country:US
Practice Address - Phone:508-374-9683
Practice Address - Fax:508-362-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1558571836OtherGENERAL DENTIST