| Brockton Family Dental Inc. | |
|
4 Main St Brockton MA 02301-4027 | |
| (508) 587-7775 | |
| (508) 587-7799 |
| Full Name | Brockton Family Dental Inc. |
|---|---|
| Speciality | Dentist |
| Location | 4 Main St, Brockton, Massachusetts |
| Authorized Official Name and Position | Sang Bae (OWNER) |
| Authorized Official Contact | 5085877775 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brockton Family Dental Inc. 4 Main St Brockton MA 02301-4027 Ph: (508) 587-7775 | Brockton Family Dental Inc. 4 Main St Brockton MA 02301-4027 Ph: (508) 587-7775 |
| NPI Number | 1235212226 |
|---|---|
| Provider Enumeration Date | 10/23/2006 |
| Last Update Date | 03/05/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235212226 | NPI | - | NPPES |
| 9734180 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 20758 (Massachusetts) | Primary |
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