# HARRIS DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760686679
- **Authorized official:** DR. JAY M HARRIS DDS (DENTIST)
- **Authorized official phone:** (208) 529-4500

## Contact information

- **Practice address:** 3815 WASHINGTON PKWY, IDAHO FALLS, ID 83404
- **Practice address phone:** (208) 529-4500
- **Mailing address:** 3815 WASHINGTON PKWY, IDAHO FALLS, ID 83404
- **Mailing address phone:** (208) 529-4500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 1641 | ID | Yes |

## Other

- **Enumeration date:** 06/13/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 852027 | INSURANCE | ID |