Provider Demographics
NPI:1881457083
Name:RICK K. HARRISON, D.M.D., PA
Entity type:Organization
Organization Name:RICK K. HARRISON, D.M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-241-4237
Mailing Address - Street 1:227 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-6529
Mailing Address - Country:US
Mailing Address - Phone:904-241-4237
Mailing Address - Fax:
Practice Address - Street 1:227 11TH AVE S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-6529
Practice Address - Country:US
Practice Address - Phone:904-241-4237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental