Healthcare Provider Details

I. General information

NPI: 1497283691
Provider Name (Legal Business Name): DAVID CALVIN HARRIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 01/12/2021
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 KIRBY CENTER CV # 6611
MEMPHIS TN
38115-4313
US

IV. Provider business mailing address

6425 N QUAIL HOLLOW RD STE 101
MEMPHIS TN
38120-1438
US

V. Phone/Fax

Practice location:
  • Phone: 901-363-8192
  • Fax:
Mailing address:
  • Phone: 901-861-9668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10468
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number10468
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: