Healthcare Provider Details

I. General information

NPI: 1174699227
Provider Name (Legal Business Name): JAMES TIMOTHY HARRIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7251 MAGNOLIA AVE
RIVERSIDE CA
92504
US

IV. Provider business mailing address

7251 MAGNOLIA AVE
RIVERSIDE CA
92504
US

V. Phone/Fax

Practice location:
  • Phone: 951-689-5031
  • Fax: 951-352-2048
Mailing address:
  • Phone: 951-689-5031
  • Fax: 951-352-2048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number45264
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: