Provider Demographics
NPI:1851487433
Name:HARRIS, JESSE BLUFORD (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:BLUFORD
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9102 RUTLAND GREENS WAY
Mailing Address - Street 2:A
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116
Mailing Address - Country:US
Mailing Address - Phone:804-559-3636
Mailing Address - Fax:804-789-8426
Practice Address - Street 1:9102 RUTLAND GREENS WAY
Practice Address - Street 2:A
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116
Practice Address - Country:US
Practice Address - Phone:804-559-3636
Practice Address - Fax:804-789-8426
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014110591223E0200X
AK12231223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics