Provider Demographics
NPI:1306040613
Name:HARRISON, HERBERT RANDALL (DDS)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:RANDALL
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 1:2522 DANA ST
Mailing Address - Street 2:STE 105
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2803
Mailing Address - Country:US
Mailing Address - Phone:510-666-0737
Mailing Address - Fax:
Practice Address - Street 1:2522 DANA ST
Practice Address - Street 2:STE 105
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704
Practice Address - Country:US
Practice Address - Phone:510-666-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD21894122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist