Provider Demographics
NPI:1558422204
Name:HARRISON, MARY CATHERINE (DDS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 BROWNCROFT BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-1410
Mailing Address - Country:US
Mailing Address - Phone:585-381-2600
Mailing Address - Fax:585-419-0566
Practice Address - Street 1:2480 BROWNCROFT BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-1410
Practice Address - Country:US
Practice Address - Phone:585-381-2600
Practice Address - Fax:585-419-0566
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040236122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7409720001Medicare NSC