MEDICARE: TARYN K. HARRELD, D.D.S., M.S., PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	2901020425	MI

General Provider Information

NPI Number	:	1073917175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARYN K. HARRELD, D.D.S., M.S., PC

Provider Business Mailing Address
First Line	:	3579 HENRY ST
Second Line	:	SUITE 120
City	:	NORTON SHORES
State	:	MI
Zip	:	49441-6720
Country	:	US
Telephone Number	:	231-733-4494
Fax Number	:

Provider Business Practice Location Address
First Line	:	3579 HENRY ST
Second Line	:	SUITE 120
City	:	NORTON SHORES
State	:	MI
Zip	:	49441-6720
Country	:	US
Telephone Number	:	231-733-4494
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TARYN K HARRELD
Credential	:	D.D.S., M.S.
Telephone Number	:	231-233-1898

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	10/17/2014

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