MEDICARE: FAMILY ORTHODONTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1407046428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY ORTHODONTICS

Provider Business Mailing Address
First Line	:	57 E MAIN ST STE 108
Second Line	:
City	:	WESTBOROUGH
State	:	MA
Zip	:	01581-1445
Country	:	US
Telephone Number	:	508-366-7976
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 E MAIN ST STE 108
Second Line	:
City	:	WESTBOROUGH
State	:	MA
Zip	:	01581-1445
Country	:	US
Telephone Number	:	508-366-7976
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PATRICK FATHI ASSIOUN I
Credential	:	DMD, MMSC
Telephone Number	:	508-366-7976

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	07/26/2007

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Directions to “FAMILY ORTHODONTICS ” Practice Location

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