Provider Demographics
NPI:1922131697
Name:SOUTHEASTERN NEW ENGLAND DENTAL GROUP
Entity Type:Organization
Organization Name:SOUTHEASTERN NEW ENGLAND DENTAL GROUP
Other - Org Name:SNEDG
Other - Org Type:Other Name
Authorized Official - Title/Position:PROSTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MSCD
Authorized Official - Phone:508-996-6777
Mailing Address - Street 1:32 HILLMAN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-6613
Mailing Address - Country:US
Mailing Address - Phone:508-996-6777
Mailing Address - Fax:508-996-6795
Practice Address - Street 1:32 HILLMAN ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6613
Practice Address - Country:US
Practice Address - Phone:508-996-6777
Practice Address - Fax:508-996-6795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA124871223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty