MEDICARE: DR. MICHAEL SETH 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)	DN16357	FL

General Provider Information

NPI Number	:	1811940281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SETH HARRIS DMD

Provider Business Mailing Address
First Line	:	12794 W FOREST HILL BLVD
Second Line	:	SUITE 27A
City	:	WELLINGTON
State	:	FL
Zip	:	33414-4710
Country	:	US
Telephone Number	:	561-204-3242
Fax Number	:	561-204-3243

Provider Business Practice Location Address
First Line	:	12794 W FOREST HILL BLVD
Second Line	:	SUITE 27A
City	:	WELLINGTON
State	:	FL
Zip	:	33414-4710
Country	:	US
Telephone Number	:	561-204-3242
Fax Number	:	561-204-3243

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/08/2007

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