Healthcare Provider Details

I. General information

NPI: 1831938455
Provider Name (Legal Business Name): AMANDA CATHERINE HARRIS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1934 E CAMELBACK RD STE 110
PHOENIX AZ
85016-4136
US

IV. Provider business mailing address

909 E CAMELBACK RD UNIT 1127
PHOENIX AZ
85014-3691
US

V. Phone/Fax

Practice location:
  • Phone: 602-854-8204
  • Fax:
Mailing address:
  • Phone: 949-350-6914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD012256
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: