Organization
SOUTHEAST ORTHODONTICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN RICHARD GAUDREAULT DMD (PRESIDENT)
(508) 880-5891
Entity
Organization
Contact information
Practice address
40 MAIN ST, LAKEVILLE, MA 02347-1607
(508) 880-5891
(508) 802-9050
Mailing address
302 BROADWAY, UNIT 6, RAYNHAM, MA 02767-1439
(508) 880-5891
(508) 802-9050
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
19702
MA
Other
Enumeration date
10/14/2016
Last updated
10/14/2016
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