Provider Demographics
NPI:1265445746
Name:BRIDGEMAN, DIANNE MYERS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:MYERS
Last Name:BRIDGEMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 NORTH RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1037
Mailing Address - Country:US
Mailing Address - Phone:781-275-7153
Mailing Address - Fax:781-275-5466
Practice Address - Street 1:41 NORTH RD
Practice Address - Street 2:SUITE 107
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1037
Practice Address - Country:US
Practice Address - Phone:781-275-7153
Practice Address - Fax:781-275-5466
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA161401223G0001X
NH20841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice