NPI 1124664925 · live from the CMS NPI Registry
Brockton Dental And Orthodontics PC
Dentist, General Practice in Brockton, MA. National Provider Identifier 1124664925, active.
NPI record
| NPI | 1124664925 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dentist, General Practice 1223G0001X |
| Practice location | 231 Main St Ste 200, Brockton, MA 02301 |
| Practice phone | 508-232-6290 |
| Mailing address | 8 Brighton St Apt 3, Charlestown, MA 02129 |
| Enumerated | November 27, 2019 |
| Last updated | November 27, 2019 |
| Authorized official | Neetu Bansal, Owner |
| Other names | Brockton Dental And Orthodontics PC |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist | 122300000X | — |
| Dentist, Orthodontics and Dentofacial Orthopedics | 1223X0400X | — |
| Dentist, General Practice primary | 1223G0001X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.