Provider Demographics
NPI:1508875329
Name:MARK R HARRISON DDS PA
Entity Type:Organization
Organization Name:MARK R HARRISON DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-778-0400
Mailing Address - Street 1:40 PORTSMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2106
Mailing Address - Country:US
Mailing Address - Phone:603-778-0400
Mailing Address - Fax:
Practice Address - Street 1:40 PORTSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2106
Practice Address - Country:US
Practice Address - Phone:603-778-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH22511223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty