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General NPI Number Information
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NPI Number | 1205146248
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Entity Type | Organization
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Legal Business Name | MICHAEL G. BROUTSAS D.D.S.,P.C.
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Dates
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Enumeration Date | 10/08/2010
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 54 WINTHROP ST
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City | TAUNTON
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State | MA
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Zip | 02780-4228
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Country | US
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Telephone | 508-824-7023
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Fax | 823-075-7508
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Provider Business Mailing Address
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Address Line | 54 WINTHROP ST
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City | TAUNTON
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State | MA
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Zip | 02780-4228
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Country | US
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Telephone | 508-824-7023
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Fax | 823-075-7508
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Authorized Official
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Title or Position | ORAL SURGEON
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Name | MR. MICHAEL G BROUTSAS
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Credential | DDS
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Telephone | 508-824-7023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 12159
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License Number State | MA
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