Provider Demographics
NPI:1033467873
Name:BRIDGE, DON PHILLIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:PHILLIP
Last Name:BRIDGE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MANVEL AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74834-3854
Mailing Address - Country:US
Mailing Address - Phone:405-258-7715
Mailing Address - Fax:405-258-4544
Practice Address - Street 1:1010 MANVEL AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-3854
Practice Address - Country:US
Practice Address - Phone:405-258-7715
Practice Address - Fax:405-258-4544
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK36101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice