NPIMap

Organization Active NPI

Southeast Orthodontics, Inc.

  • Dental Clinic/Center
  • Brockton, MA
National Provider Identifier
1114095361
Registry record updated Oct 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
19702 Issued in MA
Legal business name
SOUTHEAST ORTHODONTICS, INC.
Practice address
841 Belmont St
Brockton, MA 02301-5545
Phone
(508) 587-8623
NPI assigned
Dec 4, 2006
Last updated
Oct 3, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Brian Richard Gaudreault, D.M.D.NPI 1518910348
Title
President
Phone
(508) 587-8623

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 19702 MA Primary

Addresses

Primary practice location

841 Belmont St
Brockton, MA 02301-5545

Mailing address

841 Belmont Street
Brockton, MA 02030
Phone (508) 587-8623

National Provider Directory

National Provider Directory
Tax ID family
Southeast Orthodontics Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

841 Belmont St
Brockton, MA 02301
Phone (508) 587-8623

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475452800000",
    "number": "1114095361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "841 BELMONT STREET",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "02030",
            "telephone_number": "508-587-8623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 BELMONT ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023015545",
            "telephone_number": "508-587-8623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST ORTHODONTICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2016-10-03",
        "status": "A",
        "authorized_official_last_name": "GAUDREAULT",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "508-587-8623",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MA",
            "license": "19702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.