MEDICARE: HARRELL DENTISTRY COLUMBUS LLC

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

General Provider Information

NPI Number	:	1861105793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRELL DENTISTRY COLUMBUS LLC

Provider Business Mailing Address
First Line	:	1239 BOWIE ST
Second Line	:
City	:	COLUMBUS
State	:	TX
Zip	:	78934-2343
Country	:	US
Telephone Number	:	979-942-9002
Fax Number	:

Provider Business Practice Location Address
First Line	:	1239 BOWIE ST
Second Line	:
City	:	COLUMBUS
State	:	TX
Zip	:	78934-2343
Country	:	US
Telephone Number	:	979-942-9002
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARY HARRELL
Credential	:	DDS
Telephone Number	:	713-817-6808

Provider Enumeration Date	:	01/05/2023
Last Update Date	:	01/05/2023

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