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General NPI Number Information
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NPI Number | 1578614152
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Entity Type | Organization
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Legal Business Name | HARRIS DENTURE DESIGN INC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 E MAIN ST
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City | FRANKLIN
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State | ID
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Zip | 83237-5115
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Country | US
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Telephone | 208-646-2211
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Fax |
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Provider Business Mailing Address
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Address Line | 22 N STATE ST
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City | FRANKLIN
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State | ID
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Zip | 83237-5094
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Country | US
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Telephone | 208-646-2211
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Fax |
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Authorized Official
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Title or Position | DENTURIST
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Name | MR. WILLIAM JOSEPH HARRIS
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Credential | LD
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Telephone | 208-646-2211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122400000X
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Taxonomy Name | Denturist
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License Number | LD -39
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License Number State | ID
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