Jerry R Harrison, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19A15654 Issued in IL

Practice address

2490 N Water St
Suite 11
Decatur, IL 62526-4251

Phone

(217) 875-1677

Fax

(217) 875-1834

NPI assigned

Oct 14, 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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1160784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295825602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2490 N WATER ST",
            "address_2": "SUITE 11",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625264251",
            "telephone_number": "217-875-1677",
            "fax_number": "217-875-1834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2490 N WATER ST",
            "address_2": "SUITE 11",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625264251",
            "telephone_number": "217-875-1677",
            "fax_number": "217-875-1834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRISON",
        "first_name": "JERRY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19A15654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheyanne Harris
• Denisha Harris
• Ervin Harris, RBT
• Jo'Ell Harris
• Rachel Gail Harris, CRNA
• Andrew Leroy Hartman, PHARMD
• Jamie Leigh Hartman, PHARMD
• Mary F Hartman, CRNA
• Mindy Jo Hartwig
• Mohammad Hasnain, M.D.

• General Practice Dentistry in Decatur, IL
• Providers in Decatur, IL by specialty
• General Practice Dentistry in Illinois

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.