Provider Demographics
NPI:1528187887
Name:HARRIS, MARKHAM JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARKHAM
Middle Name:JAY
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 1:2408 S MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-3624
Mailing Address - Country:US
Mailing Address - Phone:660-582-8282
Mailing Address - Fax:660-582-8210
Practice Address - Street 1:2408 S MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-3624
Practice Address - Country:US
Practice Address - Phone:660-582-8282
Practice Address - Fax:660-582-8210
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080029201223G0001X
IDD38401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice