Stephen Paul Harrison, DDS
Individual provider Active NPI General Practice Dentistry · Zillah, WA
NPI 1609894963 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1609894963
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DE00005935 (WA)
- Practice address
- 781 Roza Dr
Zillah, WA 98953-9351 - Phone
- (509) 829-5466
- Fax
- (509) 829-5038
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170418002495 | WA | Order and Referring Only - General Practice |
2567748080 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE00005935 | WA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DE00005935 | WA | Yes |
Addresses
Primary practice location
781 Roza Dr
Zillah, WA 98953-9351
Mailing address
781 Roza Dr
Zillah, WA 98953-9351
Phone (509) 829-5466
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5032552 | Medicaid | WA | |
| 911993371 0001 | Other | WA | ELECTRONIC ID NUMBER |
Other providers in Zillah, WA
- Chase Elwood
- Keslie Shea Flink
- Peter Grunert
- Boanerges Guzman
- Harrison Health, PC
- Brian Scott Hatch
- Robert J Hayes
- HD Rose LLC
- Dean Albert Hill
- Katharine Lou Nadia Holmstrom
All providers in Zillah, WA · General Practice Dentistry in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.