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General NPI Number Information
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NPI Number | 1063850642
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Entity Type | Organization
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Legal Business Name | MICHAEL D. HARRIS DMD, P. C.
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Dates
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Enumeration Date | 06/05/2013
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Last Update Date | 06/05/2013
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Provider Practice Location Address
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Address Line | 3314 GATEWAY ST CROSSROADS CENTER
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City | SPRINGFIELD
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State | OR
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Zip | 97477-1054
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Country | US
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Telephone | 541-747-9830
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Fax | 252-208-7065
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Provider Business Mailing Address
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Address Line | 3314 GATEWAY ST CROSSROADS CENTER
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City | SPRINGFIELD
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State | OR
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Zip | 97477-1054
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Country | US
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Telephone | 541-747-9830
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Fax | 252-208-7065
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | DR. MICHAEL D. HARRIS
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Credential | DMD
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Telephone | 541-747-9830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D8580
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License Number State | OR
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