MEDICARE: BRIAN THOMAS HARRISON DDS

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
1	1223G0001X	General Practice Dentistry	D14972	MN

General Provider Information

NPI Number	:	1194502427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN THOMAS HARRISON DDS

Provider Business Mailing Address
First Line	:	20785 HOLYOKE AVE
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-9825
Country	:	US
Telephone Number	:	952-469-5213
Fax Number	:

Provider Business Practice Location Address
First Line	:	20785 HOLYOKE AVE
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-9825
Country	:	US
Telephone Number	:	952-469-5213
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	03/12/2025

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