Healthcare Provider Details

I. General information

NPI: 1821145186
Provider Name (Legal Business Name): JAMES H HARRIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 COLE ST
ENUMCLAW WA
98022-2602
US

IV. Provider business mailing address

1233 COLE ST
ENUMCLAW WA
98022-2602
US

V. Phone/Fax

Practice location:
  • Phone: 360-825-5527
  • Fax: 360-802-2563
Mailing address:
  • Phone: 360-825-5527
  • Fax: 360-802-2563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00003814
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier734911
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerUNITED CONCORDIA PROVIDER
# 2
Identifier5004593
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: