Provider Demographics
NPI:1033371695
Name:BRIDGETOWER DENTAL
Entity Type:Organization
Organization Name:BRIDGETOWER DENTAL
Other - Org Name:THOMAS U COX
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:URGEL
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-898-9355
Mailing Address - Street 1:3250 N TOWERBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-8347
Mailing Address - Country:US
Mailing Address - Phone:208-898-9355
Mailing Address - Fax:208-898-9363
Practice Address - Street 1:3250 N TOWERBRIDGE WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-8347
Practice Address - Country:US
Practice Address - Phone:208-898-9355
Practice Address - Fax:208-898-9363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD31951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty