NPIMap

Organization Active NPI

Harrison Dental Group IV LLC

  • General Practice Dentistry
  • Fort Wayne, IN
National Provider Identifier
1801499702
Registry record updated Nov 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
HARRISON DENTAL GROUP IV LLC
Practice address
2801 Maplecrest Rd
Fort Wayne, IN 46815-7015
Phone
(260) 747-4747
NPI assigned
Nov 21, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2020

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

Authorized official

Name
Keith Harrison
Title
Manager
Phone
(260) 747-4747

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

2801 Maplecrest Rd
Fort Wayne, IN 46815-7015

Mailing address

6412 Winchester Rd
Fort Wayne, IN 46819-1550
Phone (260) 747-4747

National Provider Directory

National Provider Directory

NPI Registry JSON

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": "1801499702",
    "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": "2801 MAPLECREST RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468157015",
            "telephone_number": "260-747-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRISON DENTAL GROUP IV 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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • 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.