Provider Demographics
NPI:1912576828
Name:HARBISON, AUSTIN BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:BRUCE
Last Name:HARBISON
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 1:540 SUMMER BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2292
Mailing Address - Country:US
Mailing Address - Phone:828-773-6052
Mailing Address - Fax:
Practice Address - Street 1:555 12TH ST NW STE L300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20004-1259
Practice Address - Country:US
Practice Address - Phone:202-783-3368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN20000571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice