Provider Demographics
NPI:1740342005
Name:HARRIS, BRUCE ALAN (DDS)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:ALAN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 W JEFFERSON
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50213
Mailing Address - Country:US
Mailing Address - Phone:641-342-6541
Mailing Address - Fax:641-342-6542
Practice Address - Street 1:148 WEST JEFFERSON
Practice Address - Street 2:BRUCE A HARRIS DDS PC
Practice Address - City:OSCEOLA
Practice Address - State:IA
Practice Address - Zip Code:50213
Practice Address - Country:US
Practice Address - Phone:641-342-6541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA062751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0149104Medicaid