Provider Demographics
NPI:1144438276
Name:MICHAEL E HARRIS DDS PSC
Entity type:Organization
Organization Name:MICHAEL E HARRIS DDS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:502-348-9775
Mailing Address - Street 1:218 W JOHN FITCH
Mailing Address - Street 2:
Mailing Address - City:BANDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004
Mailing Address - Country:US
Mailing Address - Phone:502-348-9775
Mailing Address - Fax:502-348-2756
Practice Address - Street 1:218 W JOHN FITCH
Practice Address - Street 2:
Practice Address - City:BANDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004
Practice Address - Country:US
Practice Address - Phone:502-348-9775
Practice Address - Fax:502-348-2756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4122122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61900049Medicaid