NPIMap

Organization Active NPI

Southeast Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Nantucket, MA
National Provider Identifier
1568800803
Registry record updated Jun 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
SOUTHEAST ORTHODONTICS
Practice address
19 1/2 Surfside Road
Nantucket, MA 02554
Phone
(508) 228-1085
NPI assigned
Jun 10, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2013

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

Authorized official

Name
Brian Gaudreault
Title
Owner
Phone
(508) 587-8623

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X Primary

Addresses

Primary practice location

19 1/2 Surfside Road
Nantucket, MA 02554

Mailing address

841 Belmont St
Brockton, MA 02301-5545
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

NPI Registry JSON

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

{
    "created_epoch": "1370822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370822400000",
    "number": "1568800803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "841 BELMONT ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023015545",
            "telephone_number": "508-587-8623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 1/2 SURFSIDE ROAD",
            "city": "NANTUCKET",
            "state": "MA",
            "postal_code": "02554",
            "telephone_number": "508-228-1085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST ORTHODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-10",
        "last_updated": "2013-06-10",
        "status": "A",
        "authorized_official_last_name": "GAUDREAULT",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-587-8623"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nantucket, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2013; 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.