Provider Demographics
NPI:1174673800
Name:HARRIS, JAY JASON (DMD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:JASON
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 1:220 CHRISTIANA MEDICAL CENTER
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-1652
Mailing Address - Country:US
Mailing Address - Phone:302-453-1400
Mailing Address - Fax:302-453-9553
Practice Address - Street 1:220 CHRISTIANA MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-1652
Practice Address - Country:US
Practice Address - Phone:302-453-1400
Practice Address - Fax:302-453-9553
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG10001169122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist