Provider Demographics
NPI:1255420337
Name:HARRISON, RONALD RAY (DMD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:RAY
Last Name:HARRISON
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:PO BOX 798
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-0798
Mailing Address - Country:US
Mailing Address - Phone:601-947-9530
Mailing Address - Fax:601-947-9595
Practice Address - Street 1:13 PLAZA DR
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-6095
Practice Address - Country:US
Practice Address - Phone:601-947-9530
Practice Address - Fax:601-947-9595
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2485-891223G0001X
MS24851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS200007117Medicaid
640871900OtherBC BS OF TEXAS
640871900OtherBC BS OF GA
640871900OtherBC BS OF IL
849469OtherUNITED CONCORDIA
640871900OtherBC BS OF LA
640871900OtherASSURANT
MS00660149Medicaid
640871900OtherWAUSAU
MS05237756Medicaid
640871900OtherDELTA DENTAL OF CA
640871900OtherMETLIFE
640871900OtherGENWORTH
640871900OtherAETNA