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General NPI Number Information
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NPI Number | 1083640007
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Entity Type | Individual
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Provider Name | MARY KATHLEEN HARRELL DMD
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Gender | Female
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 1519 NE F ST
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City | GRANTS PASS
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State | OR
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Zip | 97526-4234
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Country | US
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Telephone | 542-240-5678
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Fax |
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Provider Business Mailing Address
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Address Line | 2222 SW QUINNEY DR.
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City | PENDLETON
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State | OR
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Zip | 97801
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Country | US
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Telephone | 541-240-4497
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Fax | 541-504-3907
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D7115
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D7115
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9161076
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License Number State | ID
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