Provider Demographics
NPI:1467933275
Name:ALPHA DENTAL GROUP 2 INC
Entity Type:Organization
Organization Name:ALPHA DENTAL GROUP 2 INC
Other - Org Name:ALPHA DENTAL GROUP 2 INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOBADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-456-1939
Mailing Address - Street 1:5870 SW 8TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5052
Mailing Address - Country:US
Mailing Address - Phone:954-456-1939
Mailing Address - Fax:954-456-1940
Practice Address - Street 1:5870 SW 8TH ST STE 5
Practice Address - Street 2:
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5052
Practice Address - Country:US
Practice Address - Phone:954-456-1939
Practice Address - Fax:954-456-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN141731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty