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General NPI Number Information
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NPI Number | 1386918654
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Entity Type | Individual
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Provider Name | WILLIAM GORDON HARRIS BSC, DDS
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Gender | Male
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Dates
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Enumeration Date | 03/02/2012
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Last Update Date | 03/02/2012
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Provider Practice Location Address
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Address Line | 6965 DOUGLAS BLVD
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City | GRANITE BAY
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State | CA
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Zip | 95746-6256
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Country | US
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Telephone | 916-791-7998
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Fax | 916-791-5551
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Provider Business Mailing Address
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Address Line | 255 E 2 AVE S, BOX 654
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City | MAGRATH
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State | ALBERTA
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Zip | T0K 1J0
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Country | CA
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Telephone | 403-758-6006
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Fax | 403-320-1137
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 60905
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License Number State | CA
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