Provider Demographics
NPI:1811940281
Name:HARRIS, MICHAEL SETH (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SETH
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 1:12794 W FOREST HILL BLVD
Mailing Address - Street 2:SUITE 27A
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4710
Mailing Address - Country:US
Mailing Address - Phone:561-204-3242
Mailing Address - Fax:561-204-3243
Practice Address - Street 1:12794 W FOREST HILL BLVD
Practice Address - Street 2:SUITE 27A
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4710
Practice Address - Country:US
Practice Address - Phone:561-204-3242
Practice Address - Fax:561-204-3243
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN163571223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery