MEDICARE: DR. HARISH GULATI BDS, DMD

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
1	1223G0001X	General Practice Dentistry	01470	NH

General Provider Information

NPI Number	:	1295979920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARISH GULATI BDS, DMD

Provider Business Mailing Address
First Line	:	2759 WHITE MOUNTAIN HIGHWAY
Second Line	:
City	:	N. CONWAY
State	:	NH
Zip	:	03860
Country	:	US
Telephone Number	:	617-636-0409
Fax Number	:

Provider Business Practice Location Address
First Line	:	2759 WHITE MOUNTAIN HIGHWAY
Second Line	:
City	:	N. CONWAY
State	:	NH
Zip	:	03860
Country	:	US
Telephone Number	:	617-636-0409
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2009
Last Update Date	:	06/28/2019

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