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General NPI Number Information
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NPI Number | 1093002628
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Entity Type | Individual
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Provider Name | JILLIAN M HARRISON DMD
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Gender | Female
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Dates
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Enumeration Date | 07/04/2011
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Last Update Date | 07/05/2019
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Provider Practice Location Address
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Address Line | 875 GREENLAND RD UNIT B7
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City | PORTSMOUTH
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State | NH
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Zip | 03801
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Country | US
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Telephone | 603-501-0263
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Fax |
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Provider Business Mailing Address
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Address Line | 875 GREENLAND RD UNIT B7
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City | PORTSMOUTH
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State | NH
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Zip | 03801-4162
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Country | US
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Telephone | 603-501-0263
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 04138
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License Number State | NH
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