Individual
DR. JAY M. HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3815 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7591
(208) 529-4500
(208) 524-6248
Mailing address
3815 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7591
(208) 529-4500
(208) 524-6248
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1641
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
852027
PROVIDER NUMBER
ID
Enumeration date
01/31/2007
Last updated
07/09/2007
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