Provider Demographics
NPI:1124203286
Name:HARRIS, BRAD JASON (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:JASON
Last Name:HARRIS
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Gender:M
Credentials:DMD
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Mailing Address - Street 1:345 PARKWAY 575
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3897
Mailing Address - Country:US
Mailing Address - Phone:770-924-4095
Mailing Address - Fax:770-924-4096
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 140
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-422-7630
Practice Address - Fax:770-422-6017
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
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Provider Licenses
StateLicense IDTaxonomies
GADN12915204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery