MEDICARE: DR. JAMES PRICE HARRISON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN18894	FL

General Provider Information

NPI Number	:	1760712566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES PRICE HARRISON DDS

Provider Business Mailing Address
First Line	:	3245 GARDEN ST
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32796-3004
Country	:	US
Telephone Number	:	321-269-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3245 GARDEN ST
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32796-3004
Country	:	US
Telephone Number	:	321-269-2700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2009
Last Update Date	:	12/30/2009

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