MEDICARE: DR. NORMAN HARRIS D.M.D.

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	DE00006961	WA

General Provider Information

NPI Number	:	1457344913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORMAN HARRIS D.M.D.

Provider Business Mailing Address
First Line	:	4603 210TH ST E
Second Line	:
City	:	SPANAWAY
State	:	WA
Zip	:	98387-6764
Country	:	US
Telephone Number	:	253-847-3615
Fax Number	:

Provider Business Practice Location Address
First Line	:	62MDOS/SGOD 690 BARNES BLVD.
Second Line	:
City	:	MCCHORD AFB
State	:	WA
Zip	:	98438
Country	:	US
Telephone Number	:	253-982-5505
Fax Number	:

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	07/08/2007

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