Provider Demographics
NPI:1477115822
Name:HARRIS, FREDRICK (PHD, DDS)
Entity type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 MADISON AVE FL 23
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2511
Mailing Address - Country:US
Mailing Address - Phone:646-278-4579
Mailing Address - Fax:
Practice Address - Street 1:575 MADISON AVE FL 23
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2511
Practice Address - Country:US
Practice Address - Phone:646-278-4579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-06
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT134751223P0221X
NY0637281223P0221X
NJ22DI028997001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry