Individual provider Active NPI

Richard Sterling Harris, DMD

  • Dentist
  • Fond Du Lac, WI
National Provider Identifier
1013938414
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2446 Issued in WI
Practice address
545 E Johnson St
Fond Du Lac, WI 54935-2856
Phone
(920) 924-9090
Fax
(920) 921-0800
NPI assigned
Jul 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2446 WI Primary

Addresses

Primary practice location

545 E Johnson St
Fond Du Lac, WI 54935-2856

Mailing address

69 Stoney Beach Rd
Oshkosh, WI 54902-7240
Phone (920) 426-5845

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161209000461 WI Order and Referring Only - DentistPractitioner - Dentist 6305126327

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Dental Associates LTD of Wisconsin Past Accepting new patients
Dental Assosiates Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013938414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 STONEY BEACH RD",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549027240",
            "telephone_number": "920-426-5845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 E JOHNSON ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549352856",
            "telephone_number": "920-924-9090",
            "fax_number": "920-921-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "RICHARD",
        "middle_name": "STERLING",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "2446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fond Du Lac, WI

Sources for this page

Verify at the official NPI Registry.