Provider Demographics
NPI:1811685993
Name:HARRIS, BRADEN CLINT (DMD)
Entity type:Individual
Prefix:DR
First Name:BRADEN
Middle Name:CLINT
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 1:6682 S 2850 E
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-5445
Mailing Address - Country:US
Mailing Address - Phone:801-668-4542
Mailing Address - Fax:
Practice Address - Street 1:415 MEDICAL DR STE D201
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4983
Practice Address - Country:US
Practice Address - Phone:8
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13372970-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist