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General NPI Number Information
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NPI Number | 1801665286
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Entity Type | Organization
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Legal Business Name | HOLY VINE DENTAL PLLC
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Dates
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Enumeration Date | 12/27/2023
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Last Update Date | 12/30/2023
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Provider Practice Location Address
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Address Line | 481 BEDFORD ST
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City | ABINGTON
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State | MA
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Zip | 02351-1927
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Country | US
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Telephone | 781-423-2543
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Fax |
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Provider Business Mailing Address
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Address Line | 43 SHORE DR
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City | PLYMOUTH
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State | MA
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Zip | 02360-1370
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MARIAN MEGELLY
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Credential | DMD
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Telephone | 508-785-5231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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