Healthcare Provider Details

I. General information

NPI: 1275473811
Provider Name (Legal Business Name): BRAINTREE KIDS DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WASHINGTON ST STE 301
BRAINTREE MA
02184-4768
US

IV. Provider business mailing address

400 WASHINGTON ST STE 301
BRAINTREE MA
02184-4768
US

V. Phone/Fax

Practice location:
  • Phone: 813-486-9668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. RUSHIL ATUL PATEL
Title or Position: OWNER
Credential: DMD
Phone: 813-486-9668