Healthcare Provider Details

I. General information

NPI: 1447637236
Provider Name (Legal Business Name): PATRICK ASSIOUN DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 COOLIDGE RD
BERLIN MA
01503-1326
US

IV. Provider business mailing address

116 MAIN ST STE 1 ATTN: METROWEST DENTAL CENTER
MARLBOROUGH MA
01752-3811
US

V. Phone/Fax

Practice location:
  • Phone: 508-485-2001
  • Fax:
Mailing address:
  • Phone: 978-562-7964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number20209
License Number StateMA

VIII. Authorized Official

Name: AMANDA M CHOINIERE
Title or Position: OFFICE MANAGER
Credential:
Phone: 774-535-2813