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NPI Code Detail

MEDICARE: ANDREA HARRISON D.M.D.

MEDICARE: ANDREA HARRISON D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDN1856781MA

General Provider Information

NPI Number : 1174921027
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA HARRISON D.M.D.
Provider Business Mailing Address
First Line : 116 MAIN ST STE 1
Second Line :
City : MARLBOROUGH
State : MA
Zip : 01752-3811
Country : US
Telephone Number : 508-485-2001
Fax Number : 508-485-2201
Provider Business Practice Location Address
First Line : 116 MAIN ST STE 1
Second Line :
City : MARLBOROUGH
State : MA
Zip : 01752-3811
Country : US
Telephone Number : 508-485-2001
Fax Number : 508-485-2201
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2014
Last Update Date : 12/09/2014

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