Provider Demographics
NPI:1306001896
Name:BRIDGES DENTISTRY BY DESIGN
Entity Type:Organization
Organization Name:BRIDGES DENTISTRY BY DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:C. TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:5802-486-7000
Mailing Address - Street 1:1802 NW 52ND ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-3122
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:73505-3122
Practice Address - Country:US
Practice Address - Phone:580-248-6700
Practice Address - Fax:580-248-6716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty