MEDICARE: DR. ISAIAH L HARRIS JR. D.D.S.

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	1223G0001X	General Practice Dentistry	27727	TX

General Provider Information

NPI Number	:	1366780223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISAIAH L HARRIS JR. D.D.S.

Provider Business Mailing Address
First Line	:	3610 BLACKBERRY CT
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-7010
Country	:	US
Telephone Number	:	281-772-5080
Fax Number	:

Provider Business Practice Location Address
First Line	:	1723 N AVENUE K
Second Line	:
City	:	FREEPORT
State	:	TX
Zip	:	77541-3605
Country	:	US
Telephone Number	:	979-233-1581
Fax Number	:	979-233-8355

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

Provider Enumeration Date	:	01/27/2013
Last Update Date	:	01/27/2013

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