Provider Demographics
NPI:1336263433
Name:HARRIS, FRANK OSBORNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:OSBORNE
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 1:360 N 100 E
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84318-4010
Mailing Address - Country:US
Mailing Address - Phone:435-563-9154
Mailing Address - Fax:
Practice Address - Street 1:193 E 1600 N
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1969
Practice Address - Country:US
Practice Address - Phone:435-753-5166
Practice Address - Fax:435-787-1741
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT137978-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice