MEDICARE: HARKINS FAMILY DENTISTRY, PLLC

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	261QD0000X	Dental Clinic/Center	2077-84	MS

General Provider Information

NPI Number	:	1326529074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARKINS FAMILY DENTISTRY, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 2260
Second Line	:
City	:	CLINTON
State	:	MS
Zip	:	39060-2260
Country	:	US
Telephone Number	:	601-966-6663
Fax Number	:	601-924-8622

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	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT M. HARKINS
Credential	:	DMD
Telephone Number	:	601-924-8600

Provider Enumeration Date	:	08/21/2018
Last Update Date	:	08/21/2018

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