Provider Demographics
NPI:1699768473
Name:HARRISON, RICHARD CRANDALL (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CRANDALL
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 1:2008 BLUE MESA CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4188
Mailing Address - Country:US
Mailing Address - Phone:970-669-3880
Mailing Address - Fax:970-669-3881
Practice Address - Street 1:2008 BLUE MESA CT
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4188
Practice Address - Country:US
Practice Address - Phone:970-669-3880
Practice Address - Fax:970-669-3881
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO5132122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist