Individual
MACKENZIE PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
698 CRESCENT ST, BROCKTON, MA 02302-3360
(508) 583-2256
Mailing address
802 W CLINTON ST, ELMIRA, NY 14905-2108
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN1859934
MA
Other
Enumeration date
08/10/2023
Last updated
08/10/2023
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