Provider Demographics
NPI:1700998929
Name:HARRISON, JENNIFER ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:HARRISON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20171 ICENIC TRL
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-7708
Mailing Address - Country:US
Mailing Address - Phone:952-469-3300
Mailing Address - Fax:
Practice Address - Street 1:20171 ICENIC TRL
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-7708
Practice Address - Country:US
Practice Address - Phone:952-469-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND121081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice