Provider Demographics
NPI:1376727206
Name:HARRIS MARTIN, JACQUELINE S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:S
Last Name:HARRIS MARTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 18TH ST NW
Mailing Address - Street 2:747
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-3513
Mailing Address - Country:US
Mailing Address - Phone:202-330-1688
Mailing Address - Fax:877-404-8207
Practice Address - Street 1:818 18TH ST NW
Practice Address - Street 2:747
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-3513
Practice Address - Country:US
Practice Address - Phone:202-330-1688
Practice Address - Fax:877-404-8207
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC55801223G0001X
MD132291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice