Provider Demographics
NPI:1609590074
Name:HARRISON, MICAELA (DDS)
Entity Type:Individual
Prefix:
First Name:MICAELA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MICAELA
Other - Middle Name:
Other - Last Name:BARTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:8854 N COUNTY ROAD 21 W
Mailing Address - Street 2:
Mailing Address - City:LIZTON
Mailing Address - State:IN
Mailing Address - Zip Code:46149-9457
Mailing Address - Country:US
Mailing Address - Phone:317-508-5099
Mailing Address - Fax:
Practice Address - Street 1:1316 MILL ST
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-3644
Practice Address - Country:US
Practice Address - Phone:765-362-9245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013854A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice