Southeastern Oral & Maxillofacial Surgeons Pc | |
951 North Main Street Brockton MA 02301 | |
(508) 588-0200 | |
(508) 583-6156 |
Full Name | Southeastern Oral & Maxillofacial Surgeons Pc |
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Speciality | Dentist - Oral And Maxillofacial Surgery |
Location | 951 North Main Street, Brockton, Massachusetts |
Authorized Official Name and Position | John F Coyne (PRESIDENT) |
Authorized Official Contact | 5085880200 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Southeastern Oral & Maxillofacial Surgeons Pc 951 North Main Street Brockton MA 02301 Ph: (508) 588-0200 | Southeastern Oral & Maxillofacial Surgeons Pc 951 North Main Street Brockton MA 02301 Ph: (508) 588-0200 |
NPI Number | 1225115470 |
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Provider Enumeration Date | 11/01/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1225115470 | NPI | - | NPPES |
X20040 | Medicaid | MA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223S0112X | Dentist - Oral And Maxillofacial Surgery | 18127 (Massachusetts) | Primary |
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