MEDICARE: DANIEL BRIAN 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	5570	LA
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	5570	LA
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	5570	LA

General Provider Information

NPI Number	:	1811980576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL BRIAN HARRIS DDS.

Provider Business Mailing Address
First Line	:	3100 GALLERIA DR STE 202
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70001-2196
Country	:	US
Telephone Number	:	504-456-5033
Fax Number	:	504-456-5057

Provider Business Practice Location Address
First Line	:	3100 GALLERIA DR STE 202
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70001-2196
Country	:	US
Telephone Number	:	504-456-5033
Fax Number	:	504-456-5057

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

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	10/18/2018

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