Provider Demographics
NPI:1699228486
Name:JASON R. HARRIS DDS, PA
Entity Type:Organization
Organization Name:JASON R. HARRIS DDS, PA
Other - Org Name:SOUTHERN VILLAGE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-213-2545
Mailing Address - Street 1:8838 US 70 HWY W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-4822
Mailing Address - Country:US
Mailing Address - Phone:919-550-8171
Mailing Address - Fax:
Practice Address - Street 1:8838 US 70 HWY W
Practice Address - Street 2:SUITE 100
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-4822
Practice Address - Country:US
Practice Address - Phone:919-550-8171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9744122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9744OtherNC DENTAL LICENSE NUMBER