Organization
SE ORTHO MANSFIELD, INC.
Active
Other names
Southeast Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN R GAUDREAULT DMD (OWNER/PRESIDENT)
(508) 880-5891
Entity
Organization
Contact information
Practice address
100 COPELAND DR STE 9, MANSFIELD, MA 02048-1245
(508) 339-5500
Mailing address
302 BROADWAY UNIT 6, RAYNHAM, MA 02767-1439
(508) 880-5891
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
19702
MH
Other
Enumeration date
06/06/2017
Last updated
06/06/2017
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