Provider Demographics
NPI:1922521178
Name:HARRIS, JOHN MARK (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARK
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 BROME LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37218-1038
Mailing Address - Country:US
Mailing Address - Phone:615-838-1112
Mailing Address - Fax:
Practice Address - Street 1:1916 HAYES ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2317
Practice Address - Country:US
Practice Address - Phone:615-329-1854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10562122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10562OtherTENNESSEE DENTAL LICENSE NUMBER