Healthcare Provider Details

I. General information

NPI: 1851708796
Provider Name (Legal Business Name): ERIC HARRIS DMD, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2792 S 5600 W STE 100
WEST VALLEY UT
84120-5590
US

IV. Provider business mailing address

2792 S 5600 W STE 100
WEST VALLEY UT
84120-5590
US

V. Phone/Fax

Practice location:
  • Phone: 801-969-9669
  • Fax:
Mailing address:
  • Phone: 801-635-7740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number00202242
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6013345-9921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: