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General NPI Number Information
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NPI Number | 1326529074
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Entity Type | Organization
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Legal Business Name | HARKINS FAMILY DENTISTRY, PLLC
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 2189 HENRY HILL DR
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City | JACKSON
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State | MS
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Zip | 39204-2125
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Country | US
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Telephone | 601-922-3643
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2260
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City | CLINTON
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State | MS
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Zip | 39060-2260
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Country | US
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Telephone | 601-966-6663
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Fax | 601-924-8622
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT M. HARKINS
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Credential | DMD
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Telephone | 601-924-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2077-84
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License Number State | MS
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