Provider Demographics
NPI:1629663430
Name:SOUTHBRIDGE PARTNERS II
Entity Type:Organization
Organization Name:SOUTHBRIDGE PARTNERS II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:WALSH
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-463-3594
Mailing Address - Street 1:201 UNIVERSITY BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4617
Mailing Address - Country:US
Mailing Address - Phone:303-321-1323
Mailing Address - Fax:719-481-0354
Practice Address - Street 1:201 UNIVERSITY BLVD STE 210
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4617
Practice Address - Country:US
Practice Address - Phone:303-321-1323
Practice Address - Fax:719-481-0354
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHBRIDGE PARTNERS II
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty