Provider Demographics
NPI:1801181672
Name:HARRIS, CLEMMISA LOUISE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CLEMMISA
Middle Name:LOUISE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MISEE
Other - Middle Name:LOUISE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:2007 E NETTLETON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5286
Mailing Address - Country:US
Mailing Address - Phone:931-797-1821
Mailing Address - Fax:
Practice Address - Street 1:2007 E NETTLETON AVE STE C
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5286
Practice Address - Country:US
Practice Address - Phone:870-897-2439
Practice Address - Fax:870-912-1914
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96641223P0221X
AZ92011223P0221X
AR41341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry