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General NPI Number Information
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NPI Number | 1588079354
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Entity Type | Individual
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Provider Name | RYAN HARRIS D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 1940 TAMIAMI TRL UNIT 102
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-2105
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Country | US
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Telephone | 941-625-7413
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Fax |
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Provider Business Mailing Address
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Address Line | 691 NW BLUE PKWY
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City | LEES SUMMIT
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State | MO
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Zip | 64086-5736
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Country | US
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Telephone | 816-525-2056
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Fax |
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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 | DN21510
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2017009433
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License Number State | MO
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