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Organization
SOUTHEAST ORTHODONTICS, INC.
Active
Organization
SOUTHEAST ORTHODONTICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN RICHARD GAUDREAULT D.M.D. (PRESIDENT)
(508) 587-8623
Entity
Organization
Contact information
Practice address
841 BELMONT ST, BROCKTON, MA 02301-5545
(508) 587-8623
Mailing address
841 BELMONT STREET, BROCKTON, MA 02030
(508) 587-8623
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
19702
MA
Other
Enumeration date
12/04/2006
Last updated
10/03/2016
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