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NPI Code Detail

MEDICARE: RONALD HARRISON D.D.S.

MEDICARE: RONALD HARRISON D.D.S.
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
1122300000XDentist05356OK

General Provider Information

NPI Number : 1588778856
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD HARRISON D.D.S.
Provider Business Mailing Address
First Line : 1801 E 4TH ST
Second Line :
City : OKMULGEE
State : OK
Zip : 74447-3942
Country : US
Telephone Number : 918-756-4333
Fax Number : 918-759-2081
Provider Business Practice Location Address
First Line : 1313 E 20TH ST
Second Line :
City : OKMULGEE
State : OK
Zip : 74447-6303
Country : US
Telephone Number : 918-758-2700
Fax Number : 918-758-2703
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2006
Last Update Date : 07/08/2007

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Directions to “ RONALD HARRISON D.D.S.” Practice Location

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