Healthcare Provider Details

I. General information

NPI: 1578355111
Provider Name (Legal Business Name): CHANDLER HARNAGE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5218 GOODMAN RD STE 109
OLIVE BRANCH MS
38654-7985
US

IV. Provider business mailing address

8403 TAPESTRY CIR UNIT 303
LOUISVILLE KY
40222-8310
US

V. Phone/Fax

Practice location:
  • Phone: 662-667-8813
  • Fax:
Mailing address:
  • Phone: 270-282-3193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112623
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: