Provider Demographics
NPI:1881688463
Name:HARRISON, BAILEY W (DDS)
Entity Type:Individual
Prefix:DR
First Name:BAILEY
Middle Name:W
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E CHOCTAW AVE
Mailing Address - Street 2:STE 122
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5068
Mailing Address - Country:US
Mailing Address - Phone:918-423-2605
Mailing Address - Fax:918-423-7393
Practice Address - Street 1:215 E CHOCTAW AVE
Practice Address - Street 2:STE 122
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5068
Practice Address - Country:US
Practice Address - Phone:918-423-2605
Practice Address - Fax:918-423-7393
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK44691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice