Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2901014030 | MI |
NPI | 1063592814 |
---|---|
Provider Name | Dr. Peter A Harris |
First Address | Holland, MI 49424-9675 |
Second Address | Holland, MI 49424-9675 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 09/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
744805457 | (05) | MI |