MEDICARE: DR. DAVID JAMES HARRIS JR. DDS, MSD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	30-01-9873	OH

General Provider Information

NPI Number	:	1144433046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JAMES HARRIS JR. DDS, MSD

Provider Business Mailing Address
First Line	:	3869 DARROW RD STE 209
Second Line	:
City	:	STOW
State	:	OH
Zip	:	44224-2677
Country	:	US
Telephone Number	:	330-688-3800
Fax Number	:	330-688-3100

Provider Business Practice Location Address
First Line	:	3869 DARROW RD STE 209
Second Line	:
City	:	STOW
State	:	OH
Zip	:	44224-2677
Country	:	US
Telephone Number	:	330-688-3800
Fax Number	:	330-688-3100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	01/20/2010

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