Provider Demographics
NPI:1831938455
Name:HARRIS, AMANDA CATHERINE (DDS)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:CATHERINE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 E CAMELBACK RD UNIT 1127
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-3691
Mailing Address - Country:US
Mailing Address - Phone:949-350-6914
Mailing Address - Fax:
Practice Address - Street 1:1934 E CAMELBACK RD STE 110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4136
Practice Address - Country:US
Practice Address - Phone:602-854-8204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program