Provider Demographics
NPI:1013025477
Name:BRIDGES, CARL TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:TODD
Last Name:BRIDGES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:C
Other - Middle Name:TODD
Other - Last Name:BRIDGES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1802 NW 52ND ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505
Mailing Address - Country:US
Mailing Address - Phone:580-248-6700
Mailing Address - Fax:580-248-6716
Practice Address - Street 1:1802 NW 52ND ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505
Practice Address - Country:US
Practice Address - Phone:580-248-6700
Practice Address - Fax:580-248-6716
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731496013001OtherBCBS OK