Healthcare Provider Details

I. General information

NPI: 1336241736
Provider Name (Legal Business Name): W LESTER HARRIS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 OSBORNE RD
ST MARYS GA
31558
US

IV. Provider business mailing address

2420 OSBORNE RD
ST MARYS GA
31558
US

V. Phone/Fax

Practice location:
  • Phone: 912-882-3322
  • Fax: 912-882-3838
Mailing address:
  • Phone: 912-882-3322
  • Fax: 912-882-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9348
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: