Provider Demographics
NPI:1417150988
Name:HARRISON, REX EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:REX
Middle Name:EDWARD
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 1:1615 HARRISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4658
Mailing Address - Country:US
Mailing Address - Phone:850-769-5580
Mailing Address - Fax:850-747-3636
Practice Address - Street 1:1615 HARRISON AVENUE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4658
Practice Address - Country:US
Practice Address - Phone:850-769-5580
Practice Address - Fax:850-747-3636
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 127101223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics