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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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