Basic Information
| Provider Information | |||||||||
| NPI: | 1093717308 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | HAROLD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6950 NE CAMPUS WAY | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971245611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039522125 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5401 6TH AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984062617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537612540 | ||||||||
| FaxNumber: | 2537612732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 06/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DE7287 | WA | Y | Dental Providers | Dentist | General Practice |
No ID Information.