Individual
RYAN KEITH HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
121 N MAIN AVE, BOLIVAR, MO 65613-1517
(417) 422-4540
Mailing address
121 N MAIN AVE, BOLIVAR, MO 65613-1517
(417) 422-4540
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D-4515
ID
1223G0001X
General Practice Dentistry
Primary
2021016226
MO
Other
Enumeration date
10/02/2013
Last updated
04/21/2022
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