MEDICARE: SOUTHEASTERN NEW ENGLAND DENTAL GROUP

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	1223P0700X	Prosthodontics	12487	MA

General Provider Information

NPI Number	:	1922131697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEASTERN NEW ENGLAND DENTAL GROUP

Provider Business Mailing Address
First Line	:	32 HILLMAN ST
Second Line	:
City	:	NEW BEDFORD
State	:	MA
Zip	:	02740-6613
Country	:	US
Telephone Number	:	508-996-6777
Fax Number	:	508-996-6795

Provider Business Practice Location Address
First Line	:	32 HILLMAN ST
Second Line	:
City	:	NEW BEDFORD
State	:	MA
Zip	:	02740-6613
Country	:	US
Telephone Number	:	508-996-6777
Fax Number	:	508-996-6795

Authorized Official
Title or Position	:	PROSTHODONTIST
Name	:	DR. JON A RUEL
Credential	:	DMD MSCD
Telephone Number	:	508-996-6777

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/22/2020

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