Provider Demographics
NPI:1053638122
Name:HARELICK DENTAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:HARELICK DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HARELICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-993-0515
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:508-993-0515
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:508-993-0515
Practice Address - Fax:508-993-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN123341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty