Provider Demographics
NPI:1396155875
Name:HARRISON, PHILLIP AUSTIN (DDS)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:AUSTIN
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 W SAN RAMON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3152
Mailing Address - Country:US
Mailing Address - Phone:559-284-2304
Mailing Address - Fax:
Practice Address - Street 1:1195 W SAN RAMON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3152
Practice Address - Country:US
Practice Address - Phone:559-284-2304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA624111223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery