MEDICARE: JULIE M HARRIS DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	7959	KY
2	174400000X	Specialist	7959	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50002288	OTHER	KY	PASSPORT
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154322683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE M HARRIS DMD

Provider Business Mailing Address
First Line	:	3101 BRECKENRIDGE LN
Second Line	:	STE 2D
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-2742
Country	:	US
Telephone Number	:	502-459-8012
Fax Number	:	502-459-8021

Provider Business Practice Location Address
First Line	:	3101 BRECKENRIDGE LN
Second Line	:	STE 2D
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-2742
Country	:	US
Telephone Number	:	502-459-8012
Fax Number	:	502-459-8021

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	01/09/2008

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Directions to “ JULIE M HARRIS DMD” Practice Location

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