Provider Demographics
NPI:1255337606
Name:HARRIS, BRIAN TIMOTHY (DDS)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:TIMOTHY
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 N. HERITAGE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092
Mailing Address - Country:US
Mailing Address - Phone:903-892-1200
Mailing Address - Fax:903-813-1581
Practice Address - Street 1:2921 N. HERITAGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092
Practice Address - Country:US
Practice Address - Phone:903-892-1200
Practice Address - Fax:903-813-1581
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0093916-01Medicaid
TX85D916OtherBLUECROSS/BLUESHIELD
TX750920OtherUNITED CONCORDIA