MEDICARE: DR. MARY T HARRINGTON DMD

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	122300000X	Dentist	217885	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114050440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY T HARRINGTON DMD

Provider Business Mailing Address
First Line	:	3432 W CAPITOL ST
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39209
Country	:	US
Telephone Number	:	601-352-9090
Fax Number	:	601-352-7331

Provider Business Practice Location Address
First Line	:	3432 W CAPITOL ST
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39209
Country	:	US
Telephone Number	:	601-352-9090
Fax Number	:	601-352-7331

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	12/05/2016

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