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General NPI Number Information
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NPI Number | 1275263634
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Entity Type | Individual
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Provider Name | AMBER LASHA HARRIED
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Gender | Female
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Dates
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Enumeration Date | 06/16/2022
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Last Update Date | 06/16/2022
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Provider Practice Location Address
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Address Line | 110 US 61
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City | NATCHEZ
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State | MS
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Zip | 39120
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Country | US
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Telephone | 718-406-5693
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Fax |
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Provider Business Mailing Address
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Address Line | 2722 RIVER RD
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City | FAYETTE
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State | MS
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Zip | 39069-5366
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Country | US
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Telephone | 718-406-5693
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Fax |
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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 | 4288-22
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License Number State | MS
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