Healthcare Provider Details

I. General information

NPI: 1578614152
Provider Name (Legal Business Name): HARRIS DENTURE DESIGN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E MAIN ST
FRANKLIN ID
83237-5115
US

IV. Provider business mailing address

22 N STATE ST
FRANKLIN ID
83237-5094
US

V. Phone/Fax

Practice location:
  • Phone: 208-646-2211
  • Fax:
Mailing address:
  • Phone: 208-646-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberLD -39
License Number StateID

VIII. Authorized Official

Name: MR. WILLIAM JOSEPH HARRIS
Title or Position: DENTURIST
Credential: LD
Phone: 208-646-2211