Provider Demographics
NPI:1194135517
Name:JODY S. HARRISON, DDS, MS, PLLC
Entity type:Organization
Organization Name:JODY S. HARRISON, DDS, MS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER-MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:828-255-8100
Mailing Address - Street 1:201 E CHESTNUT ST STE C
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2493
Mailing Address - Country:US
Mailing Address - Phone:828-255-8100
Mailing Address - Fax:828-255-8126
Practice Address - Street 1:201 E CHESTNUT ST STE C
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2493
Practice Address - Country:US
Practice Address - Phone:828-255-8100
Practice Address - Fax:828-255-8126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96631223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty