Provider Demographics
NPI:1467804955
Name:HARKINS, MICHAEL JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:HARKINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2260
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39060-2260
Mailing Address - Country:US
Mailing Address - Phone:601-966-3362
Mailing Address - Fax:
Practice Address - Street 1:543 HIGHWAY 80 W STE C
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4105
Practice Address - Country:US
Practice Address - Phone:601-924-8600
Practice Address - Fax:601-924-8622
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3877-16122300000X, 1223G0001X
CO00202934122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice