Provider Demographics
NPI:1184031924
Name:BRIM, MELISSA BLAIR BRIDY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:BLAIR BRIDY
Last Name:BRIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 BROADWAY STE 800
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1924
Mailing Address - Country:US
Mailing Address - Phone:877-335-8273
Mailing Address - Fax:
Practice Address - Street 1:1333 BROADWAY STE 800
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1924
Practice Address - Country:US
Practice Address - Phone:877-355-8273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN99221223G0001X
KY95721223G0001X
FLDN206061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice