Individual
DR. JEREMIAH LANCE HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
1005 W MARKET ST, SUITE 3, ATHENS, AL 35611-2454
(256) 232-1404
(256) 230-6738
Mailing address
1005 W MARKET ST, SUITE 3, ATHENS, AL 35611-2454
(256) 232-1404
(256) 230-6738
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5540
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009912189
—
AL
01
—
1991902
UCCI
AL
01
—
51543170
BLUE CROSS BLUE SHIELD AL
AL
Enumeration date
07/17/2007
Last updated
07/24/2012
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