MEDICARE: MATTHEW B. HARRISON, DDS, PA

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	3408	AR

General Provider Information

NPI Number	:	1609996545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTHEW B. HARRISON, DDS, PA

Provider Business Mailing Address
First Line	:	1107 W ELM ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-4235
Country	:	US
Telephone Number	:	479-636-1194
Fax Number	:	479-636-8549

Provider Business Practice Location Address
First Line	:	1107 W ELM ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-4235
Country	:	US
Telephone Number	:	479-636-1194
Fax Number	:	479-636-8549

Authorized Official
Title or Position	:	OWNER
Name	:	LAURA HARRISON
Credential	:
Telephone Number	:	479-636-1194

Provider Enumeration Date	:	03/31/2007
Last Update Date	:	11/02/2011

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