Healthcare Provider Details

I. General information

NPI: 1144438276
Provider Name (Legal Business Name): MICHAEL E HARRIS DDS PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 W JOHN FITCH
BANDSTOWN KY
40004
US

IV. Provider business mailing address

218 W JOHN FITCH
BANDSTOWN KY
40004
US

V. Phone/Fax

Practice location:
  • Phone: 502-348-9775
  • Fax: 502-348-2756
Mailing address:
  • Phone: 502-348-9775
  • Fax: 502-348-2756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4122
License Number StateKY

VIII. Authorized Official

Name: MICHAEL EARL HARRIS
Title or Position: PRESIDENT
Credential: DDS
Phone: 502-348-9775