Provider Demographics
NPI:1720213283
Name:HARRISON, KARINA MENDOZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARINA
Middle Name:MENDOZA
Last Name:HARRISON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KARINA
Other - Middle Name:T
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2121 KNICKERBOCKER RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-5574
Mailing Address - Country:US
Mailing Address - Phone:325-949-1004
Mailing Address - Fax:
Practice Address - Street 1:2121 KNICKERBOCKER RD
Practice Address - Street 2:SUITE C
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5574
Practice Address - Country:US
Practice Address - Phone:325-949-1004
Practice Address - Fax:325-947-2644
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist