Provider Demographics
NPI:1649449794
Name:FAMILY ORTHODONTICS, INC
Entity type:Organization
Organization Name:FAMILY ORTHODONTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSIOUN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MMSC
Authorized Official - Phone:508-366-7976
Mailing Address - Street 1:57 E MAIN ST
Mailing Address - Street 2:SUITE #108
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1464
Mailing Address - Country:US
Mailing Address - Phone:508-366-7976
Mailing Address - Fax:508-366-7876
Practice Address - Street 1:57 E MAIN ST
Practice Address - Street 2:SUITE #108
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1464
Practice Address - Country:US
Practice Address - Phone:508-366-7976
Practice Address - Fax:508-366-7876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty