Provider Demographics
NPI:1578609152
Name:STATHIS-UBERTALLI, HARRIET (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARRIET
Middle Name:
Last Name:STATHIS-UBERTALLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:HARRIET
Other - Middle Name:
Other - Last Name:STATHIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:19 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-3305
Mailing Address - Country:US
Mailing Address - Phone:339-469-1037
Mailing Address - Fax:
Practice Address - Street 1:175 DERBY ST STE 11
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4028
Practice Address - Country:US
Practice Address - Phone:781-749-9444
Practice Address - Fax:781-749-4487
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA196451223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics