Provider Demographics
NPI:1588017198
Name:KEVIN A HARRISON, DDS, PS
Entity Type:Organization
Organization Name:KEVIN A HARRISON, DDS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-653-7654
Mailing Address - Street 1:16410 SMOKEY POINT BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8415
Mailing Address - Country:US
Mailing Address - Phone:360-653-7654
Mailing Address - Fax:
Practice Address - Street 1:16410 SMOKEY POINT BLVD STE 305
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8415
Practice Address - Country:US
Practice Address - Phone:360-653-7654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00005577261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental