Provider Demographics
NPI:1699214593
Name:SOUTHBRIDGE BRACES PC
Entity type:Organization
Organization Name:SOUTHBRIDGE BRACES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOUSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALKHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-505-5040
Mailing Address - Street 1:87 ELM ST
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-1638
Mailing Address - Country:US
Mailing Address - Phone:508-589-8270
Mailing Address - Fax:508-319-3339
Practice Address - Street 1:39 ELM ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-2644
Practice Address - Country:US
Practice Address - Phone:508-909-6719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN205111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty