# HARRISON DENTAL GROUP IV LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801499702
- **Authorized official:** KEITH HARRISON (MANAGER)
- **Authorized official phone:** (260) 747-4747

## Contact information

- **Practice address:** 2801 MAPLECREST RD, FORT WAYNE, IN 46815-7015
- **Practice address phone:** (260) 747-4747
- **Mailing address:** 6412 WINCHESTER RD, FORT WAYNE, IN 46819-1550
- **Mailing address phone:** (260) 747-4747

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 11/21/2020
- **Last updated:** 11/21/2020