Healthcare Provider Details

I. General information

NPI: 1720152929
Provider Name (Legal Business Name): HOLLY TREE DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 ROCKLAND STREET
HANOVER MA
02339
US

IV. Provider business mailing address

171 ROCKLAND STREET
HANOVER MA
02339
US

V. Phone/Fax

Practice location:
  • Phone: 781-826-8331
  • Fax: 781-829-0747
Mailing address:
  • Phone: 781-826-8331
  • Fax: 781-829-0747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number17285
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12528
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17593
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20805
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number17127
License Number StateMA

VIII. Authorized Official

Name: DR. ROBIN BETH FELTOON
Title or Position: OWNER DENTIST
Credential: DMD
Phone: 781-826-8331