Mark Lee Harris, DMD
Individual provider Active NPI General Practice Dentistry · Gap, PA
NPI 1164538252 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1164538252
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DS# 024108-L (PA)
- Practice address
- 5406 Lincoln Hwy
Gap, PA 17527 - Phone
- (717) 442-9488
- NPI assigned
- Aug 22, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160404001021 | PA | Order and Referring Only - Dentist |
0941507149 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS# 024108-L | PA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DS# 024108-L | PA | Yes |
Addresses
Primary practice location
5406 Lincoln Hwy
Gap, PA 17527
Mailing address
5406 Lincoln Hwy
Gap, PA 17527
Phone (717) 442-9488
Other providers in Gap, PA
- Friendly Smiles Orthodontics LLC
- Functional Wellness Centre, LLC
- Nichole Gehman
- Gloria Bernadette Gogola
- Kirby Lee Graham
- David W Hartley
- William Lee Hook Jr.
- Sarah Elizabeth Houck
- David Hunter
- Glenford Kauffman
All providers in Gap, PA · General Practice Dentistry in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.