Healthcare Provider Details

I. General information

NPI: 1407938673
Provider Name (Legal Business Name): BEVERLY HARRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BEVERLY S HARRISON DDS

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 W CARMEL DR STE 215
CARMEL IN
46032-5878
US

IV. Provider business mailing address

755 W CARMEL DR STE 215
CARMEL IN
46032-5878
US

V. Phone/Fax

Practice location:
  • Phone: 317-249-1001
  • Fax: 317-249-1003
Mailing address:
  • Phone: 317-249-1001
  • Fax: 317-249-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12009566A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: