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NPI Code Detail

MEDICARE: DR. MATTHEW JOEL HARRIS DMD

MEDICARE: DR. MATTHEW JOEL HARRIS 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
1122300000XDentist8971NC
21223G0001XGeneral Practice Dentistry3647-12MS

General Provider Information

NPI Number : 1184944290
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW JOEL HARRIS DMD
Provider Business Mailing Address
First Line : 2300 N HILLS ST
Second Line :
City : MERIDIAN
State : MS
Zip : 39305-2633
Country : US
Telephone Number : 601-474-3140
Fax Number :
Provider Business Practice Location Address
First Line : 2300 N HILLS ST
Second Line :
City : MERIDIAN
State : MS
Zip : 39305-2633
Country : US
Telephone Number : 601-474-3140
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2010
Last Update Date : 08/20/2014

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