Healthcare Provider Details

I. General information

NPI: 1295719565
Provider Name (Legal Business Name): CHERYL ANN HARRISON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 ARNOLD ST
TINKER AFB OK
73145-8105
US

IV. Provider business mailing address

116 CRAWFORD CT
NORMAN OK
73069-8642
US

V. Phone/Fax

Practice location:
  • Phone: 405-736-2000
  • Fax:
Mailing address:
  • Phone: 405-573-9682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2393
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: