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General NPI Number Information
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NPI Number | 1528187887
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Entity Type | Individual
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Provider Name | MARKHAM JAY HARRIS D.D.S
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Gender | Male
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 02/12/2013
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Provider Practice Location Address
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Address Line | 2408 S MAIN ST SUITE B
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City | MARYVILLE
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State | MO
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Zip | 64468-3624
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Country | US
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Telephone | 660-582-8282
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Fax | 660-582-8210
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Provider Business Mailing Address
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Address Line | 2408 S MAIN ST SUITE B
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City | MARYVILLE
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State | MO
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Zip | 64468-3624
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Country | US
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Telephone | 660-582-8282
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Fax | 660-582-8210
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2008002920
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D3840
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License Number State | ID
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