Provider Demographics
NPI:1184746604
Name:KEVIN M. HARRIS DDS, PLLC
Entity type:Organization
Organization Name:KEVIN M. HARRIS DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-595-5966
Mailing Address - Street 1:7201 E CAMELBACK RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3325
Mailing Address - Country:US
Mailing Address - Phone:480-423-3161
Mailing Address - Fax:480-423-8240
Practice Address - Street 1:7201 E CAMELBACK RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3325
Practice Address - Country:US
Practice Address - Phone:480-423-3161
Practice Address - Fax:480-423-8240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ39491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty