Organization
HARRIS DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAY M HARRIS DDS (DENTIST)
(208) 529-4500
Entity
Organization
Contact information
Practice address
3815 WASHINGTON PKWY, IDAHO FALLS, ID 83404
(208) 529-4500
Mailing address
3815 WASHINGTON PKWY, IDAHO FALLS, ID 83404
(208) 529-4500
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1641
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
852027
INSURANCE
ID
Enumeration date
06/13/2007
Last updated
08/22/2020
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