MEDICARE: CRAIG 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
1	122300000X	Dentist	2003031702	MO

General Provider Information

NPI Number	:	1659382778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG HARRIS DDS

Provider Business Mailing Address
First Line	:	10 COMMUNITY PLZ
Second Line	:
City	:	SULLIVAN
State	:	MO
Zip	:	63080-1567
Country	:	US
Telephone Number	:	573-860-2552
Fax Number	:	573-860-4553

Provider Business Practice Location Address
First Line	:	10 COMMUNITY PLZ
Second Line	:
City	:	SULLIVAN
State	:	MO
Zip	:	63080-1567
Country	:	US
Telephone Number	:	573-860-2552
Fax Number	:	573-860-4553

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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