Provider Demographics
NPI:1972183408
Name:LADEAU FAMILY DENTAL
Entity Type:Organization
Organization Name:LADEAU FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:A
Authorized Official - Last Name:LADEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-485-0401
Mailing Address - Street 1:11A FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-2822
Mailing Address - Country:US
Mailing Address - Phone:508-485-0401
Mailing Address - Fax:
Practice Address - Street 1:11A FLORENCE ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-2822
Practice Address - Country:US
Practice Address - Phone:508-485-0401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental