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NPI Code Detail

MEDICARE: MARY HOLLY THERIEN RDH

MEDICARE: MARY HOLLY THERIEN RDH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1124Q00000XDental HygienistDH87365MA

General Provider Information

NPI Number : 1235908534
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY HOLLY THERIEN RDH
Provider Business Mailing Address
First Line : 42 CAPE RD
Second Line :
City : MILFORD
State : MA
Zip : 01757-3292
Country : US
Telephone Number : 508-270-5750
Fax Number :
Provider Business Practice Location Address
First Line : 41 CAPE RD
Second Line :
City : MILFORD
State : MA
Zip : 01757-3276
Country : US
Telephone Number : 508-270-5750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2023
Last Update Date : 12/27/2023

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