MEDICARE: FALL RIVER DENTISTRY AND BRACES PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1223P0221X	Pediatric Dentistry
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
3	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1851851349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FALL RIVER DENTISTRY AND BRACES PC

Provider Business Mailing Address
First Line	:	5 MOUNT ROYAL AVE STE 300
Second Line	:
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-1900
Country	:	US
Telephone Number	:	508-872-3072
Fax Number	:	508-872-0781

Provider Business Practice Location Address
First Line	:	90 WILLIAM S CANNING BLVD
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02721-2338
Country	:	US
Telephone Number	:	508-689-4010
Fax Number	:	508-689-4020

Authorized Official
Title or Position	:	CHIEF REVENUE OFFICER
Name	:	TODD PACHELLO
Credential	:
Telephone Number	:	720-475-6482

Provider Enumeration Date	:	03/21/2019
Last Update Date	:	03/11/2026

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