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General NPI Number Information
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NPI Number | 1861628851
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Entity Type | Individual
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Provider Name | BRADLEY S HARRIS D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/03/2009
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 2247 N LOOP 336 W
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City | CONROE
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State | TX
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Zip | 77304-3520
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Country | US
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Telephone | 936-756-0659
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Fax |
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Provider Business Mailing Address
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Address Line | 12802 LAKE ISLAND CIR
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City | MONTGOMERY
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State | TX
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Zip | 77356-5680
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Country | US
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Telephone | 713-703-0737
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 24481
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License Number State | TX
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