MEDICARE: HARELICK DENTAL ASSOCIATES OF HOLLISTON, LLC

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	261QD0000X	Dental Clinic/Center	DN1855403	MA

General Provider Information

NPI Number	:	1750725271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARELICK DENTAL ASSOCIATES OF HOLLISTON, LLC

Provider Business Mailing Address
First Line	:	424 MASSACHUSETTS AVE
Second Line	:	#101
City	:	BOSTON
State	:	MA
Zip	:	02118-3527
Country	:	US
Telephone Number	:	617-308-8427
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 SMITH ROW
Second Line	:
City	:	HOLLISTON
State	:	MA
Zip	:	01746-2156
Country	:	US
Telephone Number	:	508-429-4675
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NATALIE HARELICK
Credential	:	DMD
Telephone Number	:	847-322-2865

Provider Enumeration Date	:	04/26/2013
Last Update Date	:	04/26/2013

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