NPIMap

Organization Active NPI

Southeast Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Raynham, MA
National Provider Identifier
1538224696
Registry record updated Oct 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
SOUTHEAST ORTHODONTICS
Practice address
302 Broadway
Unit 6
Raynham, MA 02767
Phone
(508) 880-5891
Fax
(508) 802-9050
NPI assigned
Dec 27, 2006
Last updated
Oct 4, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2016

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

Authorized official

Name
Brian Richard Gaudreault, D.M.D.
Title
President
Phone
(508) 880-5891

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X NU Primary

Addresses

Primary practice location

302 Broadway
Unit 6
Raynham, MA 02767

Mailing address

302 Broadway
Unit 6
Raynham, MA 02767
Phone (508) 880-5891

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

302 Broadway
Unit 6
Raynham, MA 02767
Phone (508) 880-5891

NPI Registry JSON

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475539200000",
    "number": "1538224696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 BROADWAY",
            "address_2": "UNIT 6",
            "city": "RAYNHAM",
            "state": "MA",
            "postal_code": "02767",
            "telephone_number": "508-880-5891",
            "fax_number": "508-802-9050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 BROADWAY",
            "address_2": "UNIT 6",
            "city": "RAYNHAM",
            "state": "MA",
            "postal_code": "02767",
            "telephone_number": "508-880-5891",
            "fax_number": "508-802-9050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST ORTHODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2016-10-04",
        "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": "508-880-5891",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raynham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 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.