MEDICARE: ARCH ORTHODONTICS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1316179351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARCH ORTHODONTICS, PC

Provider Business Mailing Address
First Line	:	348 N PEARL ST
Second Line	:	SUITE 3
City	:	BROCKTON
State	:	MA
Zip	:	02301-1197
Country	:	US
Telephone Number	:	508-584-1166
Fax Number	:	508-586-0887

Provider Business Practice Location Address
First Line	:	348 N PEARL ST
Second Line	:	SUITE 3
City	:	BROCKTON
State	:	MA
Zip	:	02301-1197
Country	:	US
Telephone Number	:	508-584-1166
Fax Number	:	508-586-0887

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	REBECCA L MUGHERINI
Credential	:
Telephone Number	:	508-584-1166

Provider Enumeration Date	:	08/10/2009
Last Update Date	:	08/10/2009

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