Provider Demographics
NPI:1053934273
Name:MATTHEW HARRIS DMD PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MATTHEW HARRIS DMD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:916-415-8551
Mailing Address - Street 1:1468 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-8245
Mailing Address - Country:US
Mailing Address - Phone:916-415-8551
Mailing Address - Fax:
Practice Address - Street 1:11010 COMBIE RD STE 208
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-8948
Practice Address - Country:US
Practice Address - Phone:530-268-1445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental