Individual
HARRISON LEONIDAS KEITH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1932 S 16TH ST, WILMINGTON, NC 28401-6611
(910) 763-8129
(910) 763-8129
Mailing address
1932 SOUTH 16TH STREET, WILMINGTON, NC 28401-6611
(910) 763-8129
(910) 762-2474
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
6996
NC
1223G0001X
General Practice Dentistry
Primary
6996
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
545827
UNITED CONCORDIA
—
01
—
9009Y
BCBS
—
Enumeration date
09/27/2006
Last updated
09/28/2023
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