Provider Demographics
NPI:1992844716
Name:HARRIS, LEE JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:JAY
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 1:3700 WILSHIRE BLVD
Mailing Address - Street 2:#780
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2901
Mailing Address - Country:US
Mailing Address - Phone:213-380-7900
Mailing Address - Fax:213-382-3454
Practice Address - Street 1:3700 WILSHIRE BLVD
Practice Address - Street 2:#780
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2901
Practice Address - Country:US
Practice Address - Phone:213-380-7900
Practice Address - Fax:213-382-3454
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice