Healthcare Provider Details

I. General information

NPI: 1558486506
Provider Name (Legal Business Name): MICHAEL ALAN HARRISON D.M.D., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 N BUFFALO DR SUITE 110
LAS VEGAS NV
89129-7444
US

IV. Provider business mailing address

3600 N BUFFALO DR SUITE 110
LAS VEGAS NV
89129-7444
US

V. Phone/Fax

Practice location:
  • Phone: 702-568-1600
  • Fax: 702-254-9462
Mailing address:
  • Phone: 702-568-1600
  • Fax: 702-254-9462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-142
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: