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Organization

SOUTHEAST PEDIATRIC DENTISTRY AND ORTHODONTICS, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BRIAN RICHARD GAUDREAULT DMD (OWNER)
(508) 345-7075
Entity
Organization

Contact information

Practice address
23 COMMERCE WAY, SEEKONK, MA 02771-5816
(508) 336-4994
Mailing address
841 BELMONT ST, BROCKTON, MA 02301-5545
(508) 587-8623

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
1855240
MA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
19702
MA

Other

Enumeration date
12/20/2013
Last updated
12/20/2013
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