Healthcare Provider Details

I. General information

NPI: 1093905036
Provider Name (Legal Business Name): PATRICK ASSIOUN DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MAIN STREET
MARLBOROUGH MA
01752
US

IV. Provider business mailing address

116 MAIN STREET PATRICK ASSIOUN DMD PC
MARLBOROUGH MA
01752
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK ASSIOUN
Title or Position: OWNER
Credential:
Phone: 508-485-2001