Provider Demographics
NPI:1053631184
Name:HARELICK, NATALIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:
Last Name:HARELICK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:NATALIA
Other - Middle Name:
Other - Last Name:TCHERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:278 ALDEN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-4430
Mailing Address - Country:US
Mailing Address - Phone:508-993-0546
Mailing Address - Fax:508-993-0100
Practice Address - Street 1:278 ALDEN RD
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-4430
Practice Address - Country:US
Practice Address - Phone:508-993-0546
Practice Address - Fax:508-993-0100
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18554031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice