Provider Demographics
NPI:1871575902
Name:HARRISON, DAVID LOC (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LOC
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ESSEX AVE
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-4927
Mailing Address - Country:US
Mailing Address - Phone:978-283-4500
Mailing Address - Fax:
Practice Address - Street 1:1 ESSEX AVE
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-4927
Practice Address - Country:US
Practice Address - Phone:978-283-4500
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA193921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice