Healthcare Provider Details

I. General information

NPI: 1609792951
Provider Name (Legal Business Name): MATILYN NOEL HARSY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 MAIN ST STE 302
HILTON HEAD SC
29926-6607
US

IV. Provider business mailing address

7241 PERSIMMON RD
DU QUOIN IL
62832-4270
US

V. Phone/Fax

Practice location:
  • Phone: 843-671-7336
  • Fax:
Mailing address:
  • Phone: 618-318-9258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDGD.11514.GD
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: