Individual
DR. JERRY R HARRISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2490 N WATER ST, SUITE 11, DECATUR, IL 62526-4251
(217) 875-1677
(217) 875-1834
Mailing address
2490 N WATER ST, SUITE 11, DECATUR, IL 62526-4251
(217) 875-1677
(217) 875-1834
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19A15654
IL
Other
Enumeration date
10/14/2006
Last updated
07/08/2007
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