Provider Demographics
NPI:1104849694
Name:HARRISON, DAVID LAYTON (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LAYTON
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 1:4370 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2223
Mailing Address - Country:US
Mailing Address - Phone:801-969-1802
Mailing Address - Fax:801-966-6853
Practice Address - Street 1:4370 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84123-2223
Practice Address - Country:US
Practice Address - Phone:801-969-1802
Practice Address - Fax:801-966-6853
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT134800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist