Provider Demographics
NPI:1043355225
Name:MICHAEL J HARRISON DDS PA
Entity type:Organization
Organization Name:MICHAEL J HARRISON DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-475-2907
Mailing Address - Street 1:1421 EAST WAYZATA BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1939
Mailing Address - Country:US
Mailing Address - Phone:952-475-2907
Mailing Address - Fax:
Practice Address - Street 1:1421 EAST WAYZATA BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1939
Practice Address - Country:US
Practice Address - Phone:952-475-2907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10529122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty