Provider Demographics
NPI:1821214503
Name:HARRELSON, BRETT (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:HARRELSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 LANSDOWNE DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8406
Mailing Address - Country:US
Mailing Address - Phone:678-867-6847
Mailing Address - Fax:
Practice Address - Street 1:11180 STATE BRIDGE RD
Practice Address - Street 2:SUITE 405
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-7482
Practice Address - Country:US
Practice Address - Phone:770-777-2803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0112501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice