Provider Demographics
NPI:1891427670
Name:HARRIS, JENNA RUTH (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:RUTH
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 CHERRY LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-6640
Mailing Address - Country:US
Mailing Address - Phone:919-634-7809
Mailing Address - Fax:
Practice Address - Street 1:5400 BARBER MILL RD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-7260
Practice Address - Country:US
Practice Address - Phone:919-553-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist