1386918654 NPI number — WILLIAM GORDON HARRIS BSC, DDS

Table of content: WILLIAM GORDON HARRIS BSC, DDS (NPI 1386918654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386918654 NPI number — WILLIAM GORDON HARRIS BSC, DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
WILLIAM
Provider Middle Name:
GORDON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSC, DDS
Provider Gender Code:
M

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:
1386918654
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 E 2 AVE S,
Provider Second Line Business Mailing Address:
BOX 654
Provider Business Mailing Address City Name:
MAGRATH
Provider Business Mailing Address State Name:
ALBERTA
Provider Business Mailing Address Postal Code:
T0K 1J0
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
403-758-6006
Provider Business Mailing Address Fax Number:
403-320-1137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6965 DOUGLAS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANITE BAY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95746-6256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-791-7998
Provider Business Practice Location Address Fax Number:
916-791-5551
Provider Enumeration Date:
03/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  60905 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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