1023154960 NPI number — SHARON FREELAND HARRIS DMD PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023154960 NPI number — SHARON FREELAND HARRIS DMD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARON FREELAND HARRIS DMD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023154960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4906 MILLRIDGE PKWY EAST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLOTHIAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-744-4335
Provider Business Mailing Address Fax Number:
804-744-8211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4906 MILLRIDGE PKWY EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLOTHIAN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-744-4335
Provider Business Practice Location Address Fax Number:
804-744-8211
Provider Enumeration Date:
01/29/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
FREELAND
Authorized Official Title or Position:
PRES SEC
Authorized Official Telephone Number:
804-744-4335

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  0401008937 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 244923 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".