Organization
BROCKTON FAMILY DENTAL INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANG BAE M.D. (OWNER)
(508) 587-7775
Entity
Organization
Contact information
Practice address
4 MAIN ST, BROCKTON, MA 02301-4027
(508) 587-7775
(508) 587-7799
Mailing address
4 MAIN ST, BROCKTON, MA 02301-4027
(508) 587-7775
(508) 587-7799
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
20758
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9734180
—
MA
Enumeration date
10/23/2006
Last updated
03/05/2012
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