Provider Demographics
NPI:1114050440
Name:HARRINGTON, MARY T (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:T
Last Name:HARRINGTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:TRIPLETT
Other - Last Name:HARRINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:3432 W CAPITOL ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209
Mailing Address - Country:US
Mailing Address - Phone:601-352-9090
Mailing Address - Fax:601-352-7331
Practice Address - Street 1:3432 W CAPITOL ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209
Practice Address - Country:US
Practice Address - Phone:601-352-9090
Practice Address - Fax:601-352-7331
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS217885122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00060154Medicaid