Provider Demographics
NPI:1952598781
Name:HARRIS, GREGORY VINCENT JR (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:VINCENT
Last Name:HARRIS
Suffix:JR
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 1:1109 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-3025
Mailing Address - Country:US
Mailing Address - Phone:740-439-4799
Mailing Address - Fax:
Practice Address - Street 1:1109 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-3025
Practice Address - Country:US
Practice Address - Phone:740-439-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.022670122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist