Provider Demographics
NPI:1558321398
Name:HARRIS, ROBERT JAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAY
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 1:141 TERRACE ST
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641-1835
Mailing Address - Country:US
Mailing Address - Phone:201-384-1717
Mailing Address - Fax:201-384-1793
Practice Address - Street 1:141 TERRACE ST
Practice Address - Street 2:
Practice Address - City:HAWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07641-1835
Practice Address - Country:US
Practice Address - Phone:201-384-1717
Practice Address - Fax:201-384-1793
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice