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General NPI Number Information
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NPI Number | 1144488362
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Entity Type | Individual
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Provider Name | MARY LICKING D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/23/2008
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Last Update Date | 05/23/2008
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Provider Practice Location Address
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Address Line | 11 STRAWBERRY BANK RD APT 18
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City | NASHUA
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State | NH
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Zip | 03062-2766
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Country | US
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Telephone | 603-264-1785
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Fax |
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Provider Business Mailing Address
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Address Line | 1244 BOYLSTON ST STE 205
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City | CHESTNUT HILL
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State | MA
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Zip | 02467-2115
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Country | US
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Telephone | 617-735-0800
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Fax | 617-735-0801
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 17589
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License Number State | MA
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