Provider Demographics
NPI:1104829456
Name:HARRISON, GREGORY ERRON (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ERRON
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 1:1801 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-3853
Mailing Address - Country:US
Mailing Address - Phone:806-655-1104
Mailing Address - Fax:806-655-7453
Practice Address - Street 1:1801 4TH AVE
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-3853
Practice Address - Country:US
Practice Address - Phone:806-655-1104
Practice Address - Fax:806-655-7453
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice