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Organization
HARRISON DENTAL, LLC
Active
Organization
HARRISON DENTAL, LLC
Active
Other names
Harrison Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN TUNGATE (OFFICE MANAGER)
(317) 398-0066
Entity
Organization
Contact information
Practice address
225 S HARRISON ST, SHELBYVILLE, IN 46176-2159
(317) 398-0066
Mailing address
225 S HARRISON ST, SHELBYVILLE, IN 46176-2159
(317) 398-0066
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
12009085A
IN
1223P0300X
Periodontics
Primary
12011411A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12009085A
DENTAL LICENSE
IN
01
—
12011411A
DENTAL LICENSE
IN
01
—
1376687509
NPI TYPE 1
IN
01
—
1487775144
NPI TYPE 1
IN
Enumeration date
02/10/2014
Last updated
02/10/2014
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