Organization
SOUTHEAST ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN GAUDREAULT (OWNER)
(508) 587-8623
Entity
Organization
Contact information
Practice address
19 1/2 SURFSIDE ROAD, NANTUCKET, MA 02554
(508) 228-1085
Mailing address
841 BELMONT ST, BROCKTON, MA 02301-5545
(508) 587-8623
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
06/10/2013
Last updated
06/10/2013
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