Active NPI
Jeffrey Justin Harris, DDS
- Dentist
- O Fallon, MO
National Provider Identifier
1932336799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2009014633
- Practice address
- 1630 Market Center Dr
Suite 100
O Fallon, MO 63368-8407 - Phone
- (636) 300-4380
- NPI assigned
- Jun 18, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2009014633 | MO | Primary |
Addresses
Primary practice location
1630 Market Center Dr
Suite 100
O Fallon, MO 63368-8407
Mailing address
2006 Maury Ave
Apt 1 South
Saint Louis, MO 63110-3243
Phone (314) 504-0683
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2009014633 | MO | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jeffrey J Harris DDS | Current | Accepting new patients | |
| Lifetime Dental Care of Missouri, Richard Straus, D.M.D., P.C. | Dentist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Kirkwood, MO
- NPI 1619817111
-
- General Practice Dentistry
- O'Fallon, MO
- NPI 1285777839
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245283200000",
"number": "1932336799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2006 MAURY AVE",
"address_2": "APT 1 SOUTH",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631103243",
"telephone_number": "314-504-0683"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1630 MARKET CENTER DR",
"address_2": "SUITE 100",
"city": "O FALLON",
"state": "MO",
"postal_code": "633688407",
"telephone_number": "636-300-4380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "JEFFREY",
"middle_name": "JUSTIN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-18",
"last_updated": "2009-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MO",
"license": "2009014633",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in O Fallon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.