Provider Demographics
NPI:1871673913
Name:SOUTHBRIDGE FAMILY DENTISTRY P.C.
Entity Type:Organization
Organization Name:SOUTHBRIDGE FAMILY DENTISTRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:KISSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-798-4967
Mailing Address - Street 1:7889 S LINCOLN CT
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2651
Mailing Address - Country:US
Mailing Address - Phone:303-798-4967
Mailing Address - Fax:303-798-2403
Practice Address - Street 1:7889 S LINCOLN CT
Practice Address - Street 2:SUITE 202
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2651
Practice Address - Country:US
Practice Address - Phone:303-798-4967
Practice Address - Fax:303-798-2403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty