| Southeast Orthodontics, Inc. | |
|
841 Belmont St Brockton MA 02301-5545 | |
| (508) 587-8623 | |
| Not Available |
| Full Name | Southeast Orthodontics, Inc. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 841 Belmont St, Brockton, Massachusetts |
| Authorized Official Name and Position | Brian Richard Gaudreault (PRESIDENT) |
| Authorized Official Contact | 5085878623 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeast Orthodontics, Inc. 841 Belmont Street Brockton MA 02030 Ph: (508) 587-8623 | Southeast Orthodontics, Inc. 841 Belmont St Brockton MA 02301-5545 Ph: (508) 587-8623 |
| NPI Number | 1114095361 |
|---|---|
| Provider Enumeration Date | 12/04/2006 |
| Last Update Date | 10/03/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114095361 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 19702 (Massachusetts) | Primary |
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