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Lisa Ilene Harris, DMD
Pediatric Dentist in Southington, Connecticut
NPI 1386279834

Lisa Ilene Harris is a Pediatric Dentist based in West Hartford, CT and is specialized in Pediatric Dentistry. Lisa Ilene Harris practices in Southington, CT and has the professional credentials of DMD. The NPI Number for Lisa Ilene Harris is 1386279834 and holds a License No. 12875 (Connecticut).

The current practice location address for Lisa Ilene Harris is 264 Queen St Unit A, Southington, CT and can be reached out via phone at 860-426-2643.

Location: 264 Queen St Unit A, Southington, CT, 06119-1207
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1386279834
Provider Name
Lisa Ilene Harris
Credential
DMD
Provider Entity Type
Individual
Gender
Female
Address
264 Queen St Unit A, Southington, CT, 06119-1207
Phone Number
860-426-2643
Fax Number
Provider Enumeration Date
03/05/2020
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
264 Queen St Unit A
City
Southington
State
Connecticut
Zip
06489-1901
Phone Number
860-426-2643
Fax Number
person
Provider Business Mailing Address Details
Address
264 Queen St Unit A
City
Southington
State
Connecticut
Zip
06489-1901
Phone Number
860-426-2643
Fax Number
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
1223P0221X
License No.
13337 (Connecticut)
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
12875 (Connecticut)
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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