Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 10058 | TN |
NPI | 1073953840 |
---|---|
Provider Name | John Harrison |
First Address | Nashville, TN 37204-2242 |
Second Address | Dickson, TN 37055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2013 |
Last Update Date | 15/07/2015 |