Provider Demographics
NPI:1285649442
Name:HOLLISTON DENTAL PC
Entity Type:Organization
Organization Name:HOLLISTON DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:ANGUS
Authorized Official - Last Name:RAYMENT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD DSC
Authorized Official - Phone:508-429-4445
Mailing Address - Street 1:859 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746
Mailing Address - Country:US
Mailing Address - Phone:508-429-4445
Mailing Address - Fax:508-429-0853
Practice Address - Street 1:859 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746
Practice Address - Country:US
Practice Address - Phone:508-429-4445
Practice Address - Fax:508-429-0853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA193551223G0001X
MA213441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty