Provider Demographics
NPI:1447637236
Name:PATRICK ASSIOUN DMD PC
Entity type:Organization
Organization Name:PATRICK ASSIOUN DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHOINIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-535-2813
Mailing Address - Street 1:116 MAIN ST STE 1
Mailing Address - Street 2:ATTN: METROWEST DENTAL CENTER
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3811
Mailing Address - Country:US
Mailing Address - Phone:978-562-7964
Mailing Address - Fax:
Practice Address - Street 1:150 COOLIDGE RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MA
Practice Address - Zip Code:01503-1326
Practice Address - Country:US
Practice Address - Phone:508-485-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20209305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service