Provider Demographics
NPI:1548485337
Name:HARRIS, JAY ALLEN (DMD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:ALLEN
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 1:2570 BROOKSTONE CENTRE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904
Mailing Address - Country:US
Mailing Address - Phone:706-324-5627
Mailing Address - Fax:706-324-2231
Practice Address - Street 1:2570 BROOKSTONE CENTRE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-324-5627
Practice Address - Fax:706-324-2231
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0125281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics