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NPI Code Detail

MEDICARE: DR. KRISTINE LARAE HARRIS DDS

MEDICARE: DR. KRISTINE LARAE HARRIS DDS
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
1122300000XDentist5775NE

General Provider Information

NPI Number : 1205976172
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTINE LARAE HARRIS DDS
Provider Business Mailing Address
First Line : 2508 COTTONWOOD RD
Second Line :
City : GRAND ISLAND
State : NE
Zip : 68801-7547
Country : US
Telephone Number : 308-382-1246
Fax Number :
Provider Business Practice Location Address
First Line : 1003 W 3RD ST
Second Line :
City : GRAND ISLAND
State : NE
Zip : 68801-5831
Country : US
Telephone Number : 308-382-0110
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2007
Last Update Date : 07/08/2007

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