Provider Demographics
NPI:1508246711
Name:HARRISON, MARC ALLEN (DMD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:ALLEN
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 1:1453 W 425 S
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-3697
Mailing Address - Country:US
Mailing Address - Phone:801-520-5204
Mailing Address - Fax:
Practice Address - Street 1:2025 W 200 N STE 1
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-4300
Practice Address - Country:US
Practice Address - Phone:801-544-3323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10160807-99231223P0221X
MO20150151741223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry