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Organization

SOUTHEAST ORTHODONTICS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BRIAN RICHARD GAUDREAULT D.M.D. (PRESIDENT)
(508) 880-5891
Entity
Organization

Contact information

Practice address
302 BROADWAY, UNIT 6, RAYNHAM, MA 02767
(508) 880-5891
(508) 802-9050
Mailing address
302 BROADWAY, UNIT 6, RAYNHAM, MA 02767
(508) 880-5891
(508) 802-9050

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary

Other

Enumeration date
12/27/2006
Last updated
10/04/2016
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