Kenneth Thomas Harrison, D.D.S

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

25349 Issued in CA

Practice address

12900 Perris Blvd
Ste 201
Moreno Valley, CA 92553-4135

Phone

(951) 242-6229

Fax

(951) 242-0860

NPI assigned

Oct 12, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104915537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12900 PERRIS BLVD",
            "address_2": "STE 201",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925534135",
            "telephone_number": "951-242-6229",
            "fax_number": "951-242-0860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12900 PERRIS BLVD",
            "address_2": "STE 201",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925534135",
            "telephone_number": "951-242-6229",
            "fax_number": "951-242-0860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRISON",
        "first_name": "KENNETH",
        "middle_name": "THOMAS",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "25349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krista Marie Harris, PA-C
• Kurt Harris, PA-C
• Nikkole Harris
• Talesha Harris, RN
• James Alvin Harrison, M.D.
• Gail Montee Harriss, BA,BS
• Harry Karna D.D.S., a Professional Corporation
• Nicholas Allan Harryman, DO
• Kimberlee Harvey
• Bushra Zaidi Hasan, NP

• Orthodontics and Dentofacial Orthopedics Dentistry in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.