Organization
PHOENIX PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER MORTELLITI (OWNER)
(315) 454-6000
Entity
Organization
Contact information
Practice address
165 WESTGATE DR, BROCKTON, MA 02301-1821
(781) 335-8355
Mailing address
281 SANDERS CREEK PKWY, EAST SYRACUSE, NY 13057-1307
(315) 454-6000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13263
MA
Other
Enumeration date
09/27/2007
Last updated
09/27/2007
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