Healthcare Provider Details

I. General information

NPI: 1407046428
Provider Name (Legal Business Name): FAMILY ORTHODONTICS
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

57 E MAIN ST STE 108
WESTBOROUGH MA
01581-1445
US

IV. Provider business mailing address

57 E MAIN ST STE 108
WESTBOROUGH MA
01581-1445
US

V. Phone/Fax

Practice location:
  • Phone: 508-366-7976
  • Fax:
Mailing address:
  • Phone: 508-366-7976
  • 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 FATHI ASSIOUN I
Title or Position: OWNER
Credential: DMD, MMSC
Phone: 508-366-7976