=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114050440
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY T HARRINGTON DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2007
-----------------------------------------------------
Last Update Date | 12/05/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3432 W CAPITOL ST
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-352-9090
-----------------------------------------------------
Fax | 601-352-7331
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3432 W CAPITOL ST
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-352-9090
-----------------------------------------------------
Fax | 601-352-7331
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 217885
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------