MEDICARE: KAREN CARNEY D.D.S.

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	1223G0001X	General Practice Dentistry	1796-78	MS

General Provider Information

NPI Number	:	1326404062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN CARNEY D.D.S.

Provider Business Mailing Address
First Line	:	2189 HENRY HILL DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39204-2125
Country	:	US
Telephone Number	:	601-922-3643
Fax Number	:	601-922-3645

Provider Business Practice Location Address
First Line	:	2189 HENRY HILL DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39204-2125
Country	:	US
Telephone Number	:	601-922-3643
Fax Number	:	601-922-3645

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

Provider Enumeration Date	:	01/11/2016
Last Update Date	:	01/11/2016

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