Provider Demographics
NPI:1093905788
Name:HARRISON, PATRICK RAY (DDS)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:RAY
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 NIAGARA AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-5119
Mailing Address - Country:US
Mailing Address - Phone:503-325-7413
Mailing Address - Fax:503-325-5873
Practice Address - Street 1:762 NIAGARA AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-5119
Practice Address - Country:US
Practice Address - Phone:503-325-7413
Practice Address - Fax:503-325-5873
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-28
Last Update Date:2007-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD75111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics