1609894963 NPI number — DR. STEPHEN PAUL HARRISON DDS

Table of content: DR. STEPHEN PAUL HARRISON DDS (NPI 1609894963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609894963 NPI number — DR. STEPHEN PAUL HARRISON DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRISON
Provider First Name:
STEPHEN
Provider Middle Name:
PAUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609894963
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
781 ROZA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZILLAH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98953-9351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-829-5466
Provider Business Mailing Address Fax Number:
509-829-5038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
781 ROZA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZILLAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98953-9351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-829-5466
Provider Business Practice Location Address Fax Number:
509-829-5038
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DE00005935 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5032552 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 911993371 0001 . This is a "ELECTRONIC ID NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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