Harrison Dental Group III LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

HARRISON DENTAL GROUP III LLC

Practice address

10506 Coldwater Rd
Fort Wayne, IN 46845-1235

Phone

(260) 747-4747

NPI assigned

Nov 21, 2020

Last updated

Nov 21, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Keith HarrisonNPI 1346502713

Title

Manager

Phone

(260) 747-4747

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Keith Harrison, D.D.S.

  • General Practice Dentistry
  • Fort Wayne, IN
  • NPI 1346502713
  Authorized official Same address or phone
• Jorge Antonio Baltzell, DDS

  • Dentist
  • Fort Wayne, IN
  • NPI 1225924194
  NPD (past)

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

{
    "created_epoch": "1605916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605916800000",
    "number": "1083217970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6412 WINCHESTER RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468191550",
            "telephone_number": "260-747-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10506 COLDWATER RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451235",
            "telephone_number": "260-747-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRISON DENTAL GROUP III LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-21",
        "last_updated": "2020-11-21",
        "certification_date": "2020-11-21",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "260-747-4747"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mindy Harris, FNP
• Miranda Harris
• Sebastian M Harris, MD
• Harrison Dental Group I LLC
• Harrison Dental Group II, LLC (Harrison Dental Group)
• Harrison Dental Group IV LLC
• Chelsea L Harrison
• David K Harrison, D.D.S.
• Keith Harrison, D.D.S.
• Landon M Harrison, D.O.

• General Practice Dentistry in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2020; 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.