Individual
LISA ILENE HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
264 QUEEN ST UNIT A, SOUTHINGTON, CT 06489-1901
(860) 426-2643
Mailing address
19 ARNOLD WAY, WEST HARTFORD, CT 06119-1207
(860) 707-3216
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
13337
CT
390200000X
Student in an Organized Health Care Education/Training Program
12875
CT
Other
Enumeration date
03/05/2020
Last updated
08/12/2022
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