Individual
JED HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
834 W JOHNSON ST, FOND DU LAC, WI 54935-2018
(920) 929-7400
Mailing address
281 SANDERS CREEK PKWY, EAST SYRACUSE, NY 13057-1307
(315) 454-6000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5749
WI
Other
Enumeration date
07/20/2011
Last updated
07/20/2011
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