Healthcare Provider Details

I. General information

NPI: 1164706057
Provider Name (Legal Business Name): GEORGE W HARRISON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6721 GOVERNMENT ST STE D
BATON ROUGE LA
70806-6239
US

IV. Provider business mailing address

6721 GOVERNMENT ST STE D
BATON ROUGE LA
70806-6239
US

V. Phone/Fax

Practice location:
  • Phone: 225-923-2160
  • Fax: 225-923-3009
Mailing address:
  • Phone: 225-923-2160
  • Fax: 225-923-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3158
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: