Provider Demographics
NPI:1205057585
Name:COSBY, HARRY THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:THOMAS
Last Name:COSBY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:144 SOUTH THOMAS STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801
Mailing Address - Country:US
Mailing Address - Phone:662-840-4422
Mailing Address - Fax:662-840-4447
Practice Address - Street 1:144 SOUTH THOMAS STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801
Practice Address - Country:US
Practice Address - Phone:662-840-4422
Practice Address - Fax:662-840-4447
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24031223E0200X
MSENDO220921223E0200X
TNDS00000051621223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3030652OtherBLUE CROSS BLUE SHIELD
PA863952OtherUNITED CONCORDIA