# NORTHEAST ENT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649345711
- **Authorized official:** MS. DEBORAH CORNWALL (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (508) 207-4462

## Contact information

- **Practice address:** 299 FAUNCE CORNER RD, N. DARTMOUTH, MA 02747
- **Practice address phone:** (508) 995-0700
- **Practice address fax:** (508) 995-3070
- **Mailing address:** 299 FAUNCE CORNER RD, N. DARTMOUTH, MA 02747
- **Mailing address phone:** (508) 995-0700
- **Mailing address fax:** (508) 995-3070

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YS0123X | Facial Plastic Surgery Physician | — | NULL | Yes |
| 207YS0123X | Facial Plastic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/22/2006
- **Last updated:** 06/05/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 9773312 | — | MA |