Individual
DR. NICHOLAS MICHAEL HARRISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
90 HOPE DR BLDG 6000, MOUNTAIN HOME AFB, ID 83648-1000
(801) 362-2893
Mailing address
90 HOPE DR BLDG 6000, MOUNTAIN HOME AFB, ID 83648-1000
(801) 362-2893
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14224485-9926
UT
1223G0001X
General Practice Dentistry
Primary
14224485-9926
UT
Other
Enumeration date
05/05/2025
Last updated
08/12/2026
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