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Organization

SOUTHEASTERN ORAL & MAXILLOFACIAL SURGEONS PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JOHN F COYNE DMD (PRESIDENT)
(508) 588-0200
Entity
Organization

Contact information

Practice address
951 NORTH MAIN STREET, BROCKTON, MA 02301
(508) 588-0200
(508) 583-6156
Mailing address
951 NORTH MAIN STREET, BROCKTON, MA 02301
(508) 588-0200
(508) 583-6156

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
18127
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
X20040
MA
Enumeration date
11/01/2006
Last updated
08/22/2020
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