Provider Demographics
NPI:1336469410
Name:HARELICK, SCOTT LAWRENCE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LAWRENCE
Last Name:HARELICK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18554021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice