Provider Demographics
NPI:1114062940
Name:HARRIS, MEKA B Z (DMD)
Entity Type:Individual
Prefix:
First Name:MEKA
Middle Name:B Z
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 W PARK AVE
Mailing Address - Street 2:OCEAN ORTHODONTICS BUILDING A
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-7272
Mailing Address - Country:US
Mailing Address - Phone:732-493-4747
Mailing Address - Fax:732-493-4742
Practice Address - Street 1:804 W PARK AVE
Practice Address - Street 2:OCEAN ORTHODONTICS BUILDING A
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-7272
Practice Address - Country:US
Practice Address - Phone:732-493-4747
Practice Address - Fax:732-493-4742
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 0207641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics