Kelly Uyen Harris, DMD, MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DN21128 Issued in FL

Practice address

4413 Lemongrass Dr
Fort Myers, FL 33916-8176

Phone

(714) 417-1713

NPI assigned

Feb 13, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Kelly Harris Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Aug 13, 2021 through Aug 13, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1486944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627171200000",
    "number": "1699214452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4413 LEMONGRASS DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339168176",
            "telephone_number": "714-417-1713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4413 LEMONGRASS DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339168176",
            "telephone_number": "714-417-1713"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "204 Orchard Xing",
            "address_purpose": "LOCATION",
            "city": "Morgantown",
            "state": "WV",
            "postal_code": "265051724",
            "country_code": "US",
            "telephone_number": "714-417-1713",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "KELLY",
        "middle_name": "UYEN",
        "name_prefix": "Dr.",
        "credential": "DMD, MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-02-13",
        "last_updated": "2021-07-25",
        "certification_date": "2021-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "FL",
            "license": "DN21128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "HARRIS",
            "prefix": "DR.",
            "credential": "DMD, MS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• David S Harris, M.D.
• Donald T Harris, MD
• George F Harris IV, M.D.
• Joel Harris, MS, ATC, LAT
• Keith A Harris, MD
• Kristin Dawn Harris
• Meredith Wheeler Harris, LCSW
• Howard David Harrison, MD
• Jenna Catherine Harrison, DO
• Steven A Harrison, MD

• Orthodontics and Dentofacial Orthopedics Dentistry in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.