Individual
KENNETH THOMAS HARRISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
12900 PERRIS BLVD, STE 201, MORENO VALLEY, CA 92553-4135
(951) 242-6229
(951) 242-0860
Mailing address
12900 PERRIS BLVD, STE 201, MORENO VALLEY, CA 92553-4135
(951) 242-6229
(951) 242-0860
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
25349
CA
Other
Enumeration date
10/12/2006
Last updated
07/08/2007
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