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General NPI Number Information
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NPI Number | 1821532060
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Entity Type | Organization
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Legal Business Name | HARRIS FAMILY DENTAL, SC
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 2600 N MAYFAIR RD STE 690
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City | WAUWATOSA
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State | WI
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Zip | 53226-1309
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Country | US
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Telephone | 414-771-1228
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Fax | 414-476-2515
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Provider Business Mailing Address
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Address Line | 2600 N MAYFAIR RD STE 690
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City | WAUWATOSA
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State | WI
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Zip | 53226-1309
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Country | US
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Telephone | 414-771-1228
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Fax | 414-476-2515
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HEATHER HARRIS
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Credential | DDS
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Telephone | 414-771-1228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6238
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License Number State | WI
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