Provider Demographics
NPI:1023451325
Name:HARRIS, MICHIA JOHNSON (DDS)
Entity type:Individual
Prefix:
First Name:MICHIA
Middle Name:JOHNSON
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MICHIA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3450 OLD WASHINGTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3450 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3248
Practice Address - Country:US
Practice Address - Phone:301-645-6556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD155501223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry