Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN24897 | FL |
NPI | 1003449224 |
---|---|
Provider Name | Benjamin Rex Harrison |
First Address | Panama City, FL 32401-3911 |
Second Address | Panama City, FL 32401-2042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2020 |
Last Update Date | 30/11/2021 |