Basic Information
| Provider Information | |||||||||
| NPI: | 1457344913 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | NORMAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4603 210TH ST E | ||||||||
| Address2: | |||||||||
| City: | SPANAWAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983876764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538473615 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 62MDOS/SGOD 690 BARNES BLVD. | ||||||||
| Address2: | |||||||||
| City: | MCCHORD AFB | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539825505 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DE00006961 | WA | Y | Dental Providers | Dentist | General Practice |
No ID Information.