Provider Demographics
NPI:1720152929
Name:HOLLY TREE DENTAL
Entity type:Organization
Organization Name:HOLLY TREE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:FELTOON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-826-8331
Mailing Address - Street 1:171 ROCKLAND STREET
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339
Mailing Address - Country:US
Mailing Address - Phone:781-826-8331
Mailing Address - Fax:781-829-0747
Practice Address - Street 1:171 ROCKLAND STREET
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339
Practice Address - Country:US
Practice Address - Phone:781-826-8331
Practice Address - Fax:781-829-0747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA172851223E0200X
MA125281223G0001X
MA175931223G0001X
MA208051223G0001X
MA171271223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty