SE ORTHO MANSFIELD, INC. (NPI# 1487183265) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487183265 |
| Entity Type | Organization |
| Organization Name | SE ORTHO MANSFIELD, INC. |
| Other Organization Name | SOUTHEAST ORTHODONTICS |
| Practice Address |
100 Copeland Dr Ste 9 Mansfield MA 02048-1245 |
| Mailing Address |
302 Broadway Unit 6 Raynham MA 02767-1439 |
| Practice Telephone | 5083395500 |
| Mailing Telephone | 5088805891 |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2017-06-06 |
| Authorized Official Name | DR. BRIAN R GAUDREAULT (OWNER/PRESIDENT) |
| Authorized Official Telephone | 5088805891 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
19702 | MH | Dental Providers |
| Other Name | Type Code |
|---|---|
| Southeast Orthodontics | Doing Business As Name - Organization |
| Street Address |
100 COPELAND DR STE 9 |
| City | MANSFIELD |
| State | MA |
| Zip Code | 02048-1245 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386293181 | Taylor Dabney | Specialist/Technologist | 1912 Francis Ave, Station Pointe Apt, Mansfield, MA 02048 | 2019-09-05 |
| 1720643935 | Emily Cecilia Pavidis | Doula | 1705 West Street, Mansfield, MA 02048 | 2019-05-02 |
| 1942784244 | Mary Rego Perry | Social Worker | 19 North White Pine Lane, Mansfield, MA 02048 | 2018-09-21 |
| 1306341078 | Danielle Haradon | Student in an Organized Health Care Education/Training Program | 42 Fieldstone Drve, Mansfield, MA 02048 | 2018-03-26 |
| 1750882353 | Mansfield Physical Therapy & Wellness LLC | Physical Therapist | 200 Chauncy St Ste 4, Mansfield, MA 02048 | 2018-02-28 |
| 1548671498 | Angela Silva | Developmental Therapist | 73 Elyse Rd, Mansfield, MA 02048 | 2014-05-14 |
| 1700123049 | Christy Kelly Ciccariello | Pediatrics | 4 Samoset Way, Mansfield, MA 02048 | 2013-01-07 |
| 1659620292 | Deirdre J Manning | Physical Therapist | 31 Oxford Road, Mansfield, MA 02048 | 2012-08-29 |
| 1043514706 | Carpen, Inc. | Health Maintenance Organization | 287 School St., Mansfield, MA 02048 | 2011-01-10 |
| 1295062545 | Theresa Melchionna Rhein | Social Worker | 450 Chauncy Street, Mansfield, MA 02048 | 2009-11-06 |
| Find all providers in zip 02048 | ||||
| Taxonomy Code | 1223X0400X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Orthodontics and Dentofacial Orthopedics |
| That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588116305 | Shelley R. Tardy | Dentist | 1220 Highway 287 N, Mansfield, TX 76063-4804 | 2016-10-27 |
| 1902035835 | Steven Lee Machicek | Dentist | 3807 E Broad St Ste 101, Mansfield, TX 76063-5623 | 2009-07-13 |
| 1982895454 | David Blackwell | Dentist | 1788 Highway 157 N, Ste 105, Mansfield, TX 76063-3989 | 2007-08-08 |
| 1750508081 | Walter Charles Buchsieb II | Dentist | 2184 W 4th St, Mansfield, OH 44906-1203 | 2007-04-19 |
| 1770633257 | Island Orthodontics | Dentist | 800 Matlock Rd, Mansfield, TX 76063-9126 | 2007-01-10 |
| 1376606673 | Rick Herrmann Orthodontics Pa | Dentist | 2300 Matlock Rd, Suite 28, Mansfield, TX 76063-5019 | 2006-12-18 |
| 1770680829 | Tardy Orthodontics PC | Dentist | 1220 Hwy 287 North, Mansfield, TX 76063 | 2006-09-20 |
| 1144833286 | Williams Dental Wellness Pllc | Dentist | 1560 Highway 287 N Ste 100, Mansfield, TX 76063-8824 | 2020-08-28 |
| 1063077410 | Calvin Tardy | Dentist | 1220 Highway 287 N, Mansfield, TX 76063-4804 | 2019-05-01 |
| 1891288817 | Marisa B Reason | Dentist | 292 Chauncy St # 150, Mansfield, MA 02048-1203 | 2018-06-13 |
| Find all providers in MANSFIELD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.