Provider Demographics
NPI:1194502427
Name:HARRISON, BRIAN THOMAS (DDS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:THOMAS
Last Name:HARRISON
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20785 HOLYOKE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-9825
Mailing Address - Country:US
Mailing Address - Phone:952-469-5213
Mailing Address - Fax:
Practice Address - Street 1:20785 HOLYOKE AVE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-9825
Practice Address - Country:US
Practice Address - Phone:952-469-5213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND149721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice