Individual provider Active NPI

Benjamin Rex Harrison, DMD

  • Dentist
  • Panama City, FL
National Provider Identifier
1003449224
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN24897 Issued in FL
Practice address
1012 W 11TH St
Panama City, FL 32401-2042
Phone
(850) 819-1045
NPI assigned
Feb 17, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN24897 FL Primary

Addresses

Primary practice location

1012 W 11TH St
Panama City, FL 32401-2042

Mailing address

337 Bunkers Cove Rd
Panama City, FL 32401-3911
Phone (850) 819-1045

Other practice location 1

1120 15th St # Gc5110
Augusta, GA 30912-0004
Phone (706) 721-2251

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN24897FLMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Harrison Dental Associates CurrentSince Dec 5, 2021 Accepting new patients

Locations

1012 W 11th St
Panama City, FL 32401
Phone (850) 763-6782

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1003449224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "337 BUNKERS COVE RD",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324013911",
            "telephone_number": "850-819-1045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 W 11TH ST",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324012042",
            "telephone_number": "850-819-1045"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1120 15th St # Gc5110",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309120004",
            "country_code": "US",
            "telephone_number": "706-721-2251",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRISON",
        "first_name": "BENJAMIN",
        "middle_name": "REX",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-17",
        "last_updated": "2021-11-30",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN24897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Panama City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.