Individual
MICHAEL JEFFREY HARRISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3801 GLENKERRY CT STE 2, PORTAGE, MI 49024-0711
(269) 323-1527
Mailing address
3801 GLENKERRY CT STE 2, PORTAGE, MI 49024-0711
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
TEMPORARY
IL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
2901601232
MI
Other
Enumeration date
03/15/2018
Last updated
10/20/2022
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