| Southeastern Oral & Maxillofacial Surgeons Pc | |
|
951 North Main Street Brockton MA 02301 | |
| (508) 588-0200 | |
| (508) 583-6156 |
| Full Name | Southeastern Oral & Maxillofacial Surgeons Pc |
|---|---|
| Speciality | Dentist |
| Location | 951 North Main Street, Brockton, Massachusetts |
| Authorized Official Name and Position | John F Coyne (PRESIDENT) |
| Authorized Official Contact | 5085880200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeastern Oral & Maxillofacial Surgeons Pc 951 North Main Street Brockton MA 02301 Ph: (508) 588-0200 | Southeastern Oral & Maxillofacial Surgeons Pc 951 North Main Street Brockton MA 02301 Ph: (508) 588-0200 |
| NPI Number | 1225115470 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4981855129 |
|---|---|
| Medicare Enrollment ID | O20121115000317 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225115470 | NPI | - | NPPES |
| X20040 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 18127 (Massachusetts) | Primary |
| Provider Name | John F Coyne |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1710903695 PECOS PAC ID: 4183526213 Enrollment ID: I20040121000247 |
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