Provider Demographics
NPI:1396834396
Name:HARRISON, FRANKLIN REESE JR (DMD)
Entity type:Individual
Prefix:DR
First Name:FRANKLIN
Middle Name:REESE
Last Name:HARRISON
Suffix:JR
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 1:50 ORIGINS MAIN STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INLET BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32461-2351
Mailing Address - Country:US
Mailing Address - Phone:850-818-9006
Mailing Address - Fax:
Practice Address - Street 1:50 ORIGINS MAIN STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:INLET BEACH
Practice Address - State:FL
Practice Address - Zip Code:32461-2351
Practice Address - Country:US
Practice Address - Phone:850-818-9006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL148621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice