Individual
MARK LEE HARRIS II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
340 MAGNOLIA CIR, TYNDALL AFB, FL 32403-5604
(502) 837-4448
Mailing address
340 MAGNOLIA CIR # 5612, TYNDALL AFB, FL 32403-5612
(850) 283-2778
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401417042
VA
122300000X
Dentist
STUDENT
MD
Other
Enumeration date
04/15/2020
Last updated
09/23/2021
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