Provider Demographics
NPI:1164706057
Name:HARRISON, GEORGE W (DMD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:W
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6721 GOVERNMENT ST
Mailing Address - Street 2:STE D
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6239
Mailing Address - Country:US
Mailing Address - Phone:225-923-2160
Mailing Address - Fax:225-923-3009
Practice Address - Street 1:6721 GOVERNMENT ST
Practice Address - Street 2:STE D
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6239
Practice Address - Country:US
Practice Address - Phone:225-923-2160
Practice Address - Fax:225-923-3009
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA31581223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics