Active NPI
Mary Licking, D.D.S.
- Dentist
- Nashua, NH
National Provider Identifier
1144488362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 17589
- Practice address
- 11 Strawberry Bank Rd
Apt 18
Nashua, NH 03062-2766 - Phone
- (603) 264-1785
- NPI assigned
- May 23, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 17589 | MA | Primary |
Addresses
Primary practice location
11 Strawberry Bank Rd
Apt 18
Nashua, NH 03062-2766
Mailing address
1244 Boylston St Ste 205
Chestnut Hill, MA 02467-2115
Phone (617) 735-0800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17589 | MA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211500800000",
"number": "1144488362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1244 BOYLSTON ST STE 205",
"city": "CHESTNUT HILL",
"state": "MA",
"postal_code": "024672115",
"telephone_number": "617-735-0800",
"fax_number": "617-735-0801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 STRAWBERRY BANK RD",
"address_2": "APT 18",
"city": "NASHUA",
"state": "NH",
"postal_code": "030622766",
"telephone_number": "603-264-1785"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICKING",
"first_name": "MARY",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-23",
"last_updated": "2008-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "17589",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nashua, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.