Organization
SOUTHEASTERN DENTAL CARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MINH-PHUONG BUI D.M.D. (PRESIDENT)
(508) 947-5717
Entity
Organization
Contact information
Practice address
336 BEDFORD ST, LAKEVILLE, MA 02347-2136
(508) 947-5717
(508) 947-8405
Mailing address
336 BEDFORD ST, LAKEVILLE, MA 02347-2136
(508) 947-5717
(508) 947-8405
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
21958
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110068471A
—
MA
Enumeration date
06/28/2012
Last updated
06/28/2012
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