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General NPI Number Information
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NPI Number | 1710502778
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Entity Type | Individual
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Provider Name | CHANTAI NACOLE HARRIS DDS
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Gender | Female
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Dates
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Enumeration Date | 06/15/2020
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 2220 WISTERIA DR STE 300
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City | SNELLVILLE
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State | GA
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Zip | 30078-4604
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Country | US
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Telephone | 678-836-2107
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Fax |
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Provider Business Mailing Address
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Address Line | 2233 ROLLING ACRES DR SW
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City | CONYERS
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State | GA
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Zip | 30094-6137
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Country | US
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Telephone | 770-876-3871
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Fax |
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN122640
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License Number State | GA
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