Provider Demographics
NPI:1679696991
Name:HARRIS, JEFFREY S (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 OLD FORGE LANE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348
Mailing Address - Country:US
Mailing Address - Phone:610-388-6789
Mailing Address - Fax:610-388-7042
Practice Address - Street 1:300 OLD FORGE LANE
Practice Address - Street 2:SUITE 301
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348
Practice Address - Country:US
Practice Address - Phone:610-388-6789
Practice Address - Fax:610-388-7042
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-024622-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice