Healthcare Provider Details

I. General information

NPI: 1881676351
Provider Name (Legal Business Name): ANDREW BENNETT HARRIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 HAMILTON XING
ANTIOCH TN
37013-8408
US

IV. Provider business mailing address

809 HAMILTON XING
ANTIOCH TN
37013-8408
US

V. Phone/Fax

Practice location:
  • Phone: 615-942-6898
  • Fax: 615-942-8670
Mailing address:
  • Phone: 615-942-6898
  • Fax: 615-942-8670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS7452
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: