Provider Demographics
NPI:1053618801
Name:B.G.HARRISON D.D.S. AND ASSOCIATES, P.A.
Entity type:Organization
Organization Name:B.G.HARRISON D.D.S. AND ASSOCIATES, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATION MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JASMINKA
Authorized Official - Middle Name:
Authorized Official - Last Name:JELIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-922-9989
Mailing Address - Street 1:3805 DOONVALLEY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-7564
Mailing Address - Country:US
Mailing Address - Phone:910-922-9989
Mailing Address - Fax:
Practice Address - Street 1:1408 SKIBO RD.
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303
Practice Address - Country:US
Practice Address - Phone:910-922-9989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental