Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 51258 | CA |
NPI | 1508856840 |
---|---|
Provider Name | Dr. Mark E Harris |
First Address | Riverside, CA 92506-7800 |
Second Address | Riverside, CA 92506-7800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 23/08/2007 |