Kerisa Harriott, DMD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DN123004 Issued in GA

Practice address

1111 Johnson Ferry Rd # 10
Marietta, GA 30068-2181

Phone

(718) 764-7479

NPI assigned

Apr 11, 2012

Last updated

Jul 21, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kerisa Harriott DMD P.C.

  dba RenewALL Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Smyrna, GA
  • NPI 1851199616
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689897600000",
    "number": "1356607600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 JUSTINE WAY SE",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301262839",
            "telephone_number": "718-764-7479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 JOHNSON FERRY RD # 10",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300682181",
            "telephone_number": "718-764-7479"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27005 76th Ave",
            "address_purpose": "LOCATION",
            "city": "New Hyde Park",
            "state": "NY",
            "postal_code": "110401402",
            "country_code": "US",
            "telephone_number": "718-764-7479",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1815 Francis Lewis Blvd",
            "address_purpose": "LOCATION",
            "city": "Whitestone",
            "state": "NY",
            "postal_code": "113573836",
            "country_code": "US",
            "telephone_number": "718-746-8900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRIOTT",
        "first_name": "KERISA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-11",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NY",
            "license": "056887",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "GA",
            "license": "DN123004",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tasia R Harper, MS, APC, NCC
• Zhenelle Harper, RBT
• Jordan Rae Harrell
• Theresa Adyme Aaliyah Harrell
• Katherine Harrington, FNP-C
• Amanda Kate Harris, LCSW
• April Harris, CERTIFIED HAIR LOSS
• Berneice Harris
• Brad Jason Harris, D.M.D
• Charlett Theresa Harris, LPC012133

• Orthodontics and Dentofacial Orthopedics Dentistry in Marietta, GA
• Providers in Marietta, GA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.