MEDICARE: DR. STEPHEN PAUL 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	DE00005935	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	911993371 0001	OTHER	WA	ELECTRONIC ID NUMBER

General Provider Information

NPI Number	:	1609894963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN PAUL HARRISON DDS

Provider Business Mailing Address
First Line	:	781 ROZA DR
Second Line	:
City	:	ZILLAH
State	:	WA
Zip	:	98953-9351
Country	:	US
Telephone Number	:	509-829-5466
Fax Number	:	509-829-5038

Provider Business Practice Location Address
First Line	:	781 ROZA DR
Second Line	:
City	:	ZILLAH
State	:	WA
Zip	:	98953-9351
Country	:	US
Telephone Number	:	509-829-5466
Fax Number	:	509-829-5038

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/09/2007

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