Provider Demographics
NPI:1518155563
Name:HARRIS, JONATHAN L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3444 ELLICOTT CENTER DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4170
Mailing Address - Country:US
Mailing Address - Phone:410-465-1900
Mailing Address - Fax:
Practice Address - Street 1:3444 ELLICOTT CENTER DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4170
Practice Address - Country:US
Practice Address - Phone:410-465-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD123241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice