SE Ortho Mansfield, Inc.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

19702 Issued in MH

Legal business name

SE ORTHO MANSFIELD, INC.

Practice address

100 Copeland Dr Ste 9
Mansfield, MA 02048-1245

Phone

(508) 339-5500

NPI assigned

Jun 6, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Brian R Gaudreault, DMD

Title

Owner/President

Phone

(508) 880-5891

Specialties & licenses 1

Addresses

Other names 1

• Southeast Orthodontics Doing business as

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

{
    "created_epoch": "1496707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496707200000",
    "number": "1487183265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 BROADWAY UNIT 6",
            "city": "RAYNHAM",
            "state": "MA",
            "postal_code": "027671439",
            "telephone_number": "508-880-5891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COPELAND DR STE 9",
            "city": "MANSFIELD",
            "state": "MA",
            "postal_code": "020481245",
            "telephone_number": "508-339-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SE ORTHO MANSFIELD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-06",
        "last_updated": "2017-06-06",
        "status": "A",
        "authorized_official_last_name": "GAUDREAULT",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "508-880-5891",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MH",
            "license": "19702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Mansfield, MA
• Providers in Mansfield, MA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2017; 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.