Provider Demographics
NPI:1538399142
Name:HARRISBURG DENTAL LLC
Entity type:Organization
Organization Name:HARRISBURG DENTAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BURRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-578-3331
Mailing Address - Street 1:808 N ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:AR
Mailing Address - Zip Code:72432-1132
Mailing Address - Country:US
Mailing Address - Phone:870-578-3331
Mailing Address - Fax:870-578-3334
Practice Address - Street 1:808 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:AR
Practice Address - Zip Code:72432-1132
Practice Address - Country:US
Practice Address - Phone:870-578-3331
Practice Address - Fax:870-578-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty