Healthcare Provider Details

I. General information

NPI: 1407536733
Provider Name (Legal Business Name): MATTHEW P HARRISON DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 HYDRAULIC RD
CHARLOTTESVILLE VA
22901-8915
US

IV. Provider business mailing address

19810 W CATAWBA AVE STE A1
CORNELIUS NC
28031-4056
US

V. Phone/Fax

Practice location:
  • Phone: 434-973-2968
  • Fax:
Mailing address:
  • Phone: 704-997-8878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JALONDA SWEENEY
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 704-997-8878