Glenn R Harris, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN14867 Issued in MA

Practice address

207 Upper Main St
Edgartown, MA 02539-5927

Phone

(508) 939-9000

NPI assigned

Mar 22, 2007

Last updated

Aug 25, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

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.

• Edgartown Dental Group LLC

  • General Practice Dentistry
  • Edgartown, MA
  • NPI 1235657255
  NPD (past)
• Main Street Dental

  • Dentist
  • Edgartown, MA
  • NPI 1124359773
  NPD (past)

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692921600000",
    "number": "1730205352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 EVELYN CIR",
            "city": "CENTERVILLE",
            "state": "MA",
            "postal_code": "026323438",
            "telephone_number": "508-737-2880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 UPPER MAIN ST",
            "city": "EDGARTOWN",
            "state": "MA",
            "postal_code": "025395927",
            "telephone_number": "508-939-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "GLENN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-22",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN14867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Myles Gordon, PT
• Kristen Grella
• Victoria Haeselbarth
• David A Halsey, MD
• Sang Woo Han
• Island Health Inc. (Island Health Care)
• Island Health Inc. (Island Health Care)
• Island Health Inc. (Island Health Care Dental Center)
• Ella Jernegan
• Judy L Jones, FNP

• General Practice Dentistry in Edgartown, MA
• Providers in Edgartown, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 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.