Individual ProviderKeith A HarrisDentistDental ProvidersPractice Address200 Doctors Drive, Ste F, Jacksonville, NC 28546(910) 353-4242PECOS EnrollmentBased on the most recent information from CMS, provider Keith A Harris does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 8:18 PM.Profile DetailsProvider ID1265542369Provider TypeIndividualFull NameHarris, Keith ATitleDr.CredentialDDSGenderMaleSole ProprietorNoEnumeration Date8/30/2006Last Updated7/8/2007Contact InformationPractice LocationPractice Address200 Doctors Drive, Ste F, Jacksonville, NC 28546Phone(910) 353-4242Fax(910) 577-6421Mailing LocationMailing Address200 Doctors Drive, Ste F, Jacksonville, NC 28546Phone(910) 353-4242Fax(910) 577-6421Provider TaxonomiesCodeDescriptionLicenseCode1223G0001XPrimaryDescriptionDentistDental ProvidersLicense4565North CarolinaProvider IdentifiersIDDescriptionIssuerID8990244DescriptionMedicaidIssuerUnlistedNorth CarolinaID2996DescriptionOtherIssuerDELTANorth CarolinaID0211DescriptionOtherIssuerBCBSNorth Carolina